From the Guidelines
To lower elevated liver enzymes, focus on lifestyle modifications, including a 7-10% weight loss, a hypocaloric diet, and regular physical activity, as these interventions have been shown to improve liver enzymes and histology in patients with non-alcoholic fatty liver disease (NAFLD) 1. The most effective approach to lowering elevated liver enzymes involves a combination of dietary changes and increased physical activity.
- Aiming for a weight loss of 7-10% of total body weight through a hypocaloric diet and regular exercise can significantly improve liver enzymes and histology in patients with NAFLD 1.
- Dietary recommendations should focus on reducing total energy intake, controlling carbohydrate and fat consumption, and increasing protein intake, with a daily intake of 1,500-1,800 kcal in men and 1,200-1,500 kcal in women 1.
- Regular physical activity, such as 150-300 minutes of moderate-intensity aerobic exercise or 75-150 minutes of vigorous-intensity exercise per week, can also improve liver fat content and reduce liver enzyme levels, independent of weight loss 1.
- Additionally, reducing alcohol consumption, staying hydrated, and avoiding medications that may affect liver function can also help lower elevated liver enzymes.
- In some cases, medications such as statins may be prescribed to lower LDL-C and prevent atherosclerotic cardiovascular disease, but their use should be carefully considered in patients with decompensated cirrhosis or acute liver failure 1.
- Supplements like milk thistle, vitamin E, and N-acetylcysteine may also be beneficial in some cases, although the evidence is varied. These lifestyle modifications and interventions can help reduce inflammation, decrease oxidative stress, and support the liver's natural detoxification processes, ultimately leading to improved liver enzyme production and reduced morbidity and mortality.
From the FDA Drug Label
Among entecavir -treated subjects in these studies, on-treatment ALT elevations greater than 10 times the upper limit of normal (ULN) and greater than 2 times baseline generally resolved with continued treatment
- Lowering elevated liver enzymes with entecavir may occur as a result of continued treatment, as ALT elevations generally resolved in entecavir-treated subjects.
- Periodic monitoring of hepatic function is recommended during treatment.
- No specific instructions are provided in the label for how to lower elevated liver enzymes, other than to continue treatment and monitor hepatic function 2
From the Research
Methods to Lower Elevated Liver Enzymes
To help lower elevated liver enzymes, several methods can be employed, including:
- Dietary changes: A low-carbohydrate diet has been shown to reduce liver fat accumulation, liver inflammation, and serum liver enzyme levels in patients with non-alcoholic fatty liver disease (NAFLD) 3.
- Lifestyle interventions: Moderate-intensity lifestyle counseling interventions targeting improvement in physical activity and nutritional behaviors, and modest weight loss, can improve the health of patients with elevated liver enzymes and metabolic risk factors 4.
- Medications: Certain medications such as silymarin, pioglitazone, and vitamin E have been found to improve liver aminotransferases in patients with NAFLD 5.
- Statin use: Statins, particularly atorvastatin and rosuvastatin, may be beneficial in managing NAFLD and reducing cardiovascular disease events 6.
Additional Considerations
It is essential to note that:
- Weight gain and insulin resistance can contribute to the progression of liver fibrosis in patients with NAFLD 7.
- Patients with non-alcoholic steatohepatitis (NASH) are at a higher risk of developing end-stage liver disease and have a reduced survival rate compared to those with steatosis 7.
- Long-term follow-up is crucial for patients with NAFLD and elevated liver enzymes to monitor the progression of the disease and develop appropriate management strategies 7.