What to Know About Transaminitis (Elevated Liver Enzymes) (2023)

Transaminitis means having higher than normal levels of certain liver enzymes, called transaminases, detected on a blood test. By itself, transaminitis is not a medical condition—it's just a test result that needs to be followed-up on by a healthcare provider.

Two enzymes may be elevated: aspartate transaminase (AST) or alanine transaminase (ALT). When one of these enzymes is elevated, it might be a sign of liver disease or another medical condition.

Transaminitis is also called hypertransaminasemia, transaminase elevation, or elevated liver enzymes.

In the general population, the number of people with elevated liver enzyme levels might be 10% or higher. However, only 5% or less of these people have a serious problem with their liver.

This article will go over what you should know if your blood test shows transaminitis, including the possible causes and treatment.

What to Know About Transaminitis (Elevated Liver Enzymes) (1)


Elevated transaminase enzymes may be an indicator of medical conditions that can cause certain symptoms. These might include:

  • Fatigue
  • Itchy skin
  • Yellowed skin (jaundice)
  • Abdominal pain or swelling
  • Swelling in the legs and ankles
  • Nausea or vomiting
  • Excess bleeding from poor blood clotting

However, in many cases, people have elevated transaminase enzymes without having any symptoms. This may be especially likely if the elevations in these enzymes are not severe.

Liver Function

To understand what causes elevated transaminases and why they might be a concern, it is helpful to understand a little about the liver. Your liver is an organ that serves a variety of functions, including breaking down parts of some nutrients and removing certain toxins and metabolic byproducts.

It also plays important roles in making certain proteins, including ones used for blood clotting and for fluid management in the body.

Damage to the liver can cause many different symptoms and problems.

(Video) High Liver Enzymes | Aspartate vs Alanine Aminotransferase (AST vs. ALT) | Causes


Transaminases are a type of enzyme important for the synthesis of amino acids (the building blocks of protein). They are also called aminotransferases. Usually, the term “transaminase” is used to refer to the enzymes AST and ALT.

These enzymes can be found in the liver, but also to a lesser extent in other organs, such as the skeletal muscles, heart, and kidneys (particularly AST).

Liver Diseases That Cause Transaminitis

A number of different medical conditions can cause minor or major liver damage. This causes the release of AST and ALT into the bloodstream, causing elevated levels to show up on blood tests. Some of these potential causes include nonalcoholic fatty liver disease (NAFLD), alcoholic liver disease, liver infection (such as from hepatitis B or C), autoimmune disorders (like autoimmune hepatitis or primary biliary cholangitis), and rare genetic diseases like Wilson’s disease, hereditary hemochromatosis, or alpha-1 antitrypsin deficiency.

In the United States, the most common cause of mildly elevated transaminase levels is nonalcoholic fatty liver disease (NAFLD).

NAFLD is associated with metabolic syndrome, elevated triglycerides, low HDL cholesterol, high blood pressure, increased waist circumference, obesity, and insulin resistance (such as in pre-diabetes or type 2 diabetes).

Liver Problems From Medications

Transaminases might also be elevated as a reaction to certain medications. This might be particularly likely if a person is taking more than one medication that might damage the liver. Some common medications that sometimes cause elevations in transaminases include:

  • Blood pressure medications
  • Statin drugs (atorvastatin)
  • Medications for autoimmune disease (methotrexate)
  • Pain relievers (acetaminophen or aspirin)
  • Antidepressants (bupropion)
  • Drugs for acid reflux (omeprazole)
  • Anti-epileptics (carbamazepine and phenytoin)
  • Nonsteroidal anti-inflammatory drugs
  • Some herbs and homeopathic treatments (including germander and senna)
  • Anti-diabetic medication (glipizide)

Diseases of Other Systems

Medical conditions that affect other parts of the body can also sometimes cause elevated transaminases. (This is particularly true of elevations of AST as opposed to ALT). Some of these problems include:

  • Thyroid disorders
  • Celiac disease
  • Abnormal breakdown of red blood cells (hemolysis)
  • Certain muscle disorders (like polymyositis)


Elevated levels of transaminases are found from blood tests for ALT and AST. If your AST and ALT are elevated, you might be told that you have transaminitis. You also might be told that you have elevated liver function tests (LFTs). Liver function tests include not just AST and ALT, but other tests such as albumin and bilirubin, and alkaline phosphatase.

These can give other information about how the liver and other organs might be functioning. These tests are often performed as part of the medical diagnosis for a number of different problems. Sometimes, people learn that they have elevated liver enzymes even when they haven’t noticed troublesome symptoms.

If you have elevated transaminases, your healthcare provider will want to contextualize this with your overall health. The ratio of AST and ALT can give an indication of what type of problem might be going on. The amount of elevation is also an important diagnostic clue. For example, very high levels of transaminases likely indicate more severe, recent liver damage.

(Video) How to treat elevated liver enzymes? - Dr. Ravindra B S

Medical history and exams are also important to consider. These can help your healthcare provider gain clues about the potential causes of your elevated transaminases. For example, it’s important that your healthcare provider ask you about your alcohol intake and your medications. Your healthcare provider will also examine you for any signs of liver disease (or that of other organ systems).

Additional medical tests may also be needed. Depending on the situation, these might include additional liver function blood tests, INR (International normalized ratio) blood test, a complete blood count (CBC), iron and hepatitis tests, as well as tests for triglycerides, total cholesterol, a glucose A1C test, and/or additional tests for non-liver causes (like thyroid tests).

If transaminase levels don’t go down with treatment, follow up tests might be needed. These might include:

  • Ultrasound of the liver
  • Liver biopsy

In difficult-to-diagnosis situations, a referral to a gastroenterologist may be helpful.

Diagnosis Caveats

Elevated transaminases are not always a good indicator of how well the liver is functioning. With mild increases, there might be damage to the liver, but not enough to impair its functions. Also, increases in transaminases (particularly AST) can sometimes be caused by other kinds of medical problems.

Additionally, sometimes people may have severe liver damage but not necessarily elevated transaminases. High levels of AST and ALT usually indicate significant ongoing damage to the liver. But a person with severe liver disease might have had previous damage to the liver without showing a currently elevated AST or ALT. In this case, other tests can help fill out the clinical picture.


Elevated transaminases may indicate that you need treatment of some sort. This will depend on the underlying cause and its severity. People with symptoms of liver disease along with elevated transaminases may need more prompt interventions.

For example, if your healthcare provider suspects nonalcoholic fatty liver disease, lifestyle interventions are usually the first recommended treatment. This might include losing weight, avoiding foods that contain fructose, engaging in rigorous physical exercise, and limiting alcohol intake. Depending on the situation, other treatments might include antiviral treatments for viral hepatitis or stopping a drug causing liver damage.

You may need repeat AST, ALT, and other liver function tests after you start your treatment. This can help show how well you are responding to the treatment. Sometimes these tests reveal that mildly elevated levels of transaminases have gone down, even without treatment.

Taking Steps to Stop Liver Disease

If you do have a type of liver disease, it’s important to halt the progression of liver damage. Even if you don’t have symptoms now, your liver might be becoming gradually more damaged over time.

(Video) Diagnosis of Key Liver Diseases - Hepatitis A, B, C vs. Alcoholic vs. Ischemic (AST vs ALT Labs)

Eventually, this might cause life-threatening liver failure. Taking steps now may help you prevent long-term problems.

A Word From Verywell

You might be alarmed if you’ve been told you have transaminitis or elevated liver tests. It might be especially surprising if you had no idea that your liver could be at risk. However, try not to panic. Your healthcare provider will probably need to find out more to let you know what is going on. In most cases, your healthcare provider will be able to work with you to help protect your liver and your future health. Don’t hesitate to ask if you have any questions about possible diagnosis or treatment.

Frequently Asked Questions

  • What causes transaminitis?

    Transaminitis, high levels of certain liver enzymes, is most often caused by nonalcoholic fatty liver disease as well as alcoholic liver disease. Less common causes include drug-induced liver injury, hepatitis B and hepatitis C, and hereditary hemochromatosis.

  • What are the symptoms of elevated liver enzymes?

    Symptoms of elevated liver enzymes may include abdominal pain or swelling, excess bleeding due to poor blood clotting, fatigue, itchy skin, leg and ankle swelling, nausea or vomiting, and yellowed skin (jaundice).

    The occurrence of symptoms will depend on the underlying medical condition as well as the severity of enzyme elevation.

    (Video) Dangers Of Elevated Liver Enzymes
  • What is a liver blood test called?

    A liver panel can determine if the liver is working as expected. Also called a liver function test (LFT), it is made up of a series of blood tests that measure the enzymes, proteins, and other substances created by the liver.

    Learn More:Understanding Common Blood Tests and What They Mean

  • Does COVID-19 lead to transaminitis?

    Elevated liver enzymes are thought to occur in a median of 15% of COVID patients and possibly up to 58% of COVID patients.

    However, one study concluded that elevated liver enzymes didn't affect disease severity or outcome for hospitalized COVID patients.

    (Video) High Liver Enzymes [ALT & AST] – What Do They Mean? – Dr.Berg


What happens when you have elevation of liver transaminase levels? ›

Elevated liver enzymes often indicate inflammation or damage to cells in the liver. Inflamed or injured liver cells leak higher than normal amounts of certain chemicals, including liver enzymes, into the bloodstream, elevating liver enzymes on blood tests.

What should I do if my liver enzymes are elevated? ›

How is it treated? Treatment depends on what is causing your liver enzymes to be elevated. If your doctor thinks you have nonalcoholic fatty liver disease or the metabolic syndrome, you will need to watch your diet, stop drinking alcohol, lose weight, and control your cholesterol.

What liver enzymes are elevated in transaminitis? ›

It does a lot of this with enzymes, which are chemicals that help speed up the reactions in your liver. Two of these enzymes are alanine transaminase (ALT) and aspartate transaminase (AST). Transaminitis happens when the levels of one or both of these enzymes are higher than normal.

How do you manage transaminitis? ›

Herpes causing transaminitis can be treated with acyclovir. Acute Budd-Chiari syndrome (thrombosis of the hepatic veins) can be treated with transjugular intrahepatic portosystemic shunt (TIPS), surgical decompression, or thrombolysis. Autoimmune hepatitis can be treated with steroids.

Is transaminitis serious? ›

If a blood test shows that you have transaminitis, it's important to work with your doctor to rule out any possible underlying causes because many of them can lead to serious liver damage and even liver failure if left untreated.

How can I lower my liver transaminase levels? ›

Increase folate consumption

Introducing folate-rich food to the diet and taking folic acid supplements can help lower elevated liver enzymes. One 2016 study linked folate deficiency with increased ALT levels and liver damage and found that folic acid reduced ALT levels in people with liver damage.

Can you recover from elevated liver enzymes? ›

Sometimes, factors such as hormonal changes or reactions to medications can cause temporarily elevated liver enzyme levels. Elevated levels caused by these factors will generally return to normal in about 2 to 4 weeks without treatment.

What is the most common reason for elevated liver enzymes? ›

More common causes of elevated liver enzymes include: Over-the-counter pain medications, particularly acetaminophen (Tylenol, others) Certain prescription medications, including statin drugs used to control cholesterol. Drinking alcohol.

How long does it take for liver enzymes to return to normal? ›

Enzyme levels are abnormal secondary to hepatic injury.

Normalization should occur and it would take around one year. Even though the enzymes are expect to return to normal if there is no further toxins exposure within next four to six months, complete recovery will take up to one year.

Is transaminitis reversible? ›

Because transaminitis is not a disease, there is no treatment pattern for it. It is a good diagnostic for the success of treatments aimed at reversing the underlying diseases. Transaminitis treatment will vary depending on the cause but may include: Abstaining from alcohol.

What does elevated transaminases indicate? ›

However, very high elevations of the transaminases suggests severe liver damage, such as viral hepatitis, liver injury from lack of blood flow, or injury from drugs or toxins. Most disease processes cause ALT to rise higher than AST; AST levels double or triple that of ALT are consistent with alcoholic liver disease.

What is an alarming AST level? ›

10–40 IU/L. High. >36 U/L. >1,000 U/L are very high levels and may be a sign of liver injury or hepatitis. >40 IU/L which may be a sign of liver inflammation.

What foods bring liver enzymes down? ›

Here are a few foods to include in your healthy liver diet:
  • Coffee to help lower abnormal liver enzymes. ...
  • Greens to prevent fat buildup. ...
  • Beans and soy to reduce the risk of NAFLD. ...
  • Fish to reduce inflammation and fat levels. ...
  • Oatmeal for fiber. ...
  • Nuts to help reduce inflammation. ...
  • Turmeric to reduce markers of liver damage.
16 Sept 2021

When should you recheck elevated liver enzymes? ›

Second, if the level is less than two times the upper limit of normal, recheck the liver enzymes in 6–8 weeks and advise the patient not to drink alcohol. If the enzymes remain elevated, complete the work-up.

What is a dangerously high ALT? ›

What ALT level is considered high? The upper limit of normal for ALT is 55 IU/L. When an ALT level is double to triple the upper limit of normal, it is considered mildly elevated. Severely elevated ALT levels found in liver disease are often 50 times the upper limit of normal.

How do I make my liver healthy again? ›

Here are 13 tried and true ways to achieve liver wellness!
  1. Maintain a healthy weight. ...
  2. Eat a balanced diet. ...
  3. Exercise regularly. ...
  4. Avoid toxins. ...
  5. Use alcohol responsibly. ...
  6. Avoid the use of illicit drugs. ...
  7. Avoid contaminated needles. ...
  8. Get medical care if you're exposed to blood.
24 Jun 2021

Can stress cause elevated liver enzymes? ›

Stress and anxiety are proven to contribute to high liver enzyme levels since they can reduce blood flow to the liver. Stress is also connected to high cortisol levels, which, in turn, is connected to liver damage.

Should I be worried about my elevated liver enzymes? ›

If elevated abnormal liver enzymes are present, it could indicate liver damage, as these enzymes are normally only found within the liver. In most cases, liver enzyme levels are only mildly or temporarily elevated and don't signal a serious liver problem.

What are 4 warning signs of damaged liver? ›

If signs and symptoms of liver disease do occur, they may include:
  • Skin and eyes that appear yellowish (jaundice)
  • Abdominal pain and swelling.
  • Swelling in the legs and ankles.
  • Itchy skin.
  • Dark urine color.
  • Pale stool color.
  • Chronic fatigue.
  • Nausea or vomiting.
8 Apr 2022

What foods help liver repair? ›

11 Foods That Are Good for Your Liver
  • Coffee. Coffee is one of the best beverages you can drink to promote liver health. ...
  • Tea. ...
  • Grapefruit. ...
  • Blueberries and cranberries. ...
  • Grapes. ...
  • Prickly pear. ...
  • Beetroot juice. ...
  • Cruciferous vegetables.

What causes elevated liver enzymes in non drinkers? ›

You're more likely to develop non-alcoholic fatty liver disease if you're overweight, obese, have diabetes, high cholesterol or high triglycerides. But sometimes people end up with fatty liver disease from poor eating habits or rapid weight loss.

What drugs cause the most liver damage? ›

The 10 Worst Medications for Your Liver
  • 1) Acetaminophen (Tylenol) ...
  • 2) Amoxicillin/clavulanate (Augmentin) ...
  • 4) Amiodarone (Cordarone, Pacerone) ...
  • 5) Allopurinol (Zyloprim) ...
  • 8) Azathioprine (Imuran) ...
  • 9) Methotrexate. ...
  • 10) Risperidone (Risperdal) and quetiapine (Seroquel)
10 Feb 2019

How can I normalize my liver enzymes naturally? ›

However, the following steps can help reduce ALT levels successfully:
  1. Reducing daily alcohol intake: ...
  2. Consuming more caffeine: ...
  3. Switching to natural and organic foods: ...
  4. Consuming more fruits and vegetables: ...
  5. Increasing intake of dietary fiber: ...
  6. Exercising regularly: ...
  7. Weight reduction: ...
  8. Quitting smoking:
5 Jan 2022

What is liver transaminitis? ›

Transaminitis, high levels of certain liver enzymes, is most often caused by nonalcoholic fatty liver disease as well as alcoholic liver disease. Less common causes include drug-induced liver injury, hepatitis B and hepatitis C, and hereditary hemochromatosis.

Which is worse high AST or ALT? ›

In addition, patients with Wilson's disease or cirrhosis due to viral hepatitis may have an AST that is greater than the ALT, though the ratio typically is not greater than two. When the AST is higher than ALT, a muscle source of these enzymes should be considered.
AST/ALT ratio
LOINC16325-3, 1916-6

What level of AST indicates liver damage? ›

A normal AST:ALT ratio should be <1. In patients with alcoholic liver disease, the AST:ALT ratio is >1 in 92% of patients, and >2 in 70%. AST:ALT scores >2 are, therefore, strongly suggestive of alcoholic liver disease and scores <1 more suggestive of NAFLD/NASH.

What is considered extremely high AST and ALT? ›

Although levels of ALT and AST can be extremely elevated (exceeding 2,000 U per L in cases of hepatocyte injury and necrosis related to drugs, toxins, ischemia, and hepatitis), elevations less than five times the upper limit of normal (i.e., about 250 U per L and below) are much more common in primary care medicine.

Which fruit is best for liver? ›

Fill your fruit basket with apples, grapes and citrus fruits like oranges and lemons, which are proven to be liver-friendly fruits. Consume grapes as it is, in the form of a grape juice or supplement your diet with grape seed extracts to increase antioxidant levels in your body and protect your liver from toxins.

Is banana good for liver? ›

A. Yes, bananas are rich in vitamin B6, C and A. It is also high in resistant starch, which is highly beneficial for liver health. These nutrients make sure that the liver functions correctly.

How can I detox my liver in 3 days? ›

The 3-day detox juice cleanse involves consuming only blended juices and water for 3 days.
In general, the following steps are taken in a specific order:
  1. Morning detox tea.
  2. Breakfast drink.
  3. Supplements.
  4. Lunch drink.
  5. Supplements (multivitamins, omega-3 fatty acids, and probiotics)
  6. Snack drink.
  7. Dinner drink.
  8. Detox ultra-bath.
8 Mar 2022

How common is elevated liver enzymes? ›

It is estimated that approximately 10% of the U.S. population has elevated transaminase levels. An approach based on the prevalence of diseases that cause asymptomatic transaminase elevations can help clinicians efficiently identify common and serious liver disease.

What does elevated liver transaminase mean? ›

The most common causes of elevated transaminase levels are nonalcoholic fatty liver disease and alcoholic liver disease. Uncommon causes include drug-induced liver injury, hepatitis B and C, and hereditary hemochromatosis. Rare causes include alpha1-antitrypsin deficiency, autoimmune hepatitis, and Wilson disease.

Should I be worried about elevated liver enzymes? ›

If elevated abnormal liver enzymes are present, it could indicate liver damage, as these enzymes are normally only found within the liver. In most cases, liver enzyme levels are only mildly or temporarily elevated and don't signal a serious liver problem.

What causes sudden elevation in liver enzymes? ›

Liver diseases, medical conditions, medications and infections can cause elevated liver enzymes. Common causes for elevated liver enzymes include: Certain medications, such as cholesterol-lowering drugs (statins) and acetaminophen. Fatty liver disease, including alcohol-related and non-alcohol-related conditions.

How fast can liver enzymes go down? ›

Normalization should occur and it would take around one year. Even though the enzymes are expect to return to normal if there is no further toxins exposure within next four to six months, complete recovery will take up to one year.

Can stress and anxiety cause elevated liver enzymes? ›

Stress and anxiety are proven to contribute to high liver enzyme levels since they can reduce blood flow to the liver. Stress is also connected to high cortisol levels, which, in turn, is connected to liver damage.

What medications cause high liver enzymes? ›

Official answer
  • The antibiotics synthetic penicillin, ciprofloxacin and tetracycline.
  • The anti-seizure drugs carbamazepine and phenytoin and valproic acid.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • The diabetes drugs sulfonylureas and glipizide.
  • The tuberculosis drugs isoniazid, pyrazinamide and rifampin.
7 Mar 2022

Can dehydration cause elevated liver enzymes? ›

In conclusion, hepatic enzymes can be temporary elevated in patients with uncomplicated acute AGE with severe dehydration.

When should I worry about AST and ALT? ›

Persistent mild elevation of ALT and AST in asymptomatic persons should be followed up and if the levels go above 2 times the normal range, further evaluation is necessary.


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4. Liver Function Test Interpretation (LFTs) | Liver Enzymes Remastered (Bilirubin, GGT, Alk Phos)
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