How Long Does it Take to Lower Liver Enzymes?
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What are the factors affecting the time that liver enzymes take to lower?
The time liver enzymes take to revert to normal depends on more than one factor.
A. The cause of elevated liver enzymes.
The most crucial factor determining the recovery time is the original cause of elevated liver enzymes.
Some diseases cause acute and transient elevation of liver enzymes such as drugs. On the other hand, Other conditions may cause prolonged elevations of the liver enzymes such as NAFLD (nonalcoholic fatty liver disease).
So, we divided the answer to the question (how long does it take to lower live enzymes) into different sections according to the cause.
B. The degree of elevation.
The degree of the elevation of liver enzymes often reflects the severity of the disease. If two patients with the exact cause (for example, acute hepatitis A), the one with more elevated liver enzymes often takes more time to recover.
The higher is the level of liver enzymes, the more time it takes to lower.
- Slightly Elevated Liver Enzymes (100 U/L or less): 7 Causes Explained.
- When to worry about ALT levels?
C. Compliance with treatment and diet.
People who take their medications and stick to dietary advice often recover quickly. However, the liver enzymes may take more time to lower if you don’t receive the correct treatment or dosing.
Also, people who eat unhealthy food, such as fatty food, fail to recover quickly.
Below, we will explain the time the liver enzymes take to lower the most common liver diseases.
1. Acute Viral Hepatitis.
Viral infections are among the most common causes of acute hepatitis (reference).
The most common viruses that cause acute hepatitis include:
- Hepatitis A virus: Acquired via the ingestion of contaminated foods or drinks.
- Hepatitis B virus: Acquired through blood and body fluids (through wounds or during medical procedures).
- Hepatitis C virus: acquired in the same way as HBV.
- Others such as Cytomegalovirus, Ebstein Barr virus, etc.
The hepatitis A virus is the most important and the most common cause of acute hepatitis, especially in children.
Acute Hepatitis A: how long does it take to lower liver enzymes?
Acute hepatitis A results from contacting an infected person, eating or drinking contaminated foods or drinks.
The virus is known to cause acute and severe degrees of elevation of liver enzymes (ALT and AST).
The following facts will help you understand the time it takes to lower liver enzymes with hepatitis A infection.
- The time between infection and the appearance of symptoms of acute hepatitis A often ranges between 15-50 days.
- The elevation of liver enzymes (ALT and AST) is often higher than 1000 International units/dL.
- The liver enzymes take about 4 to 6 weeks to lower (after the appearance of symptoms.
- The figure below illustrates that the liver enzyme (ALT) takes around 7 to 8 weeks to lower from the time of infection (not the time of symptom appearance) (reference).
2. Medication-induced liver injury.
Many drugs can cause injury to the liver. The pattern of medication-induced liver injury is either:
- Elevated liver enzymes (ALT and AST) without a significant rise in The Alkaline phosphatase enzymes (ALP) → called hepatocellular injury.
- An elevation of bilirubin and ALP without the significant rise of ALT and AST → called cholestasis or cholestatic pattern.
- There is a rise in ALT, AST, ALP, and bilirubin → The Mixed type.
- Other patterns of injury include acute fatty liver, NAFLD, sinusoidal obstruction syndrome, and others.
Over 1000 medications and herbal products can cause elevated liver enzymes. Common offending medications include:
- Painkillers (NSAIDs): as ibuprofen, Paracetamol, Diclophenac, etc.
- Birth control pills.
- Some antibiotics include Erythromycin, Isoniazid, Tetrycyclines, Sulfa, Amoxicillin-clavulanate, and others.
- Statins (cholesterol and lipid-lowering drugs.
- Some anesthetic drugs.
- And many others, See this searchable database.
Essential facts about the liver enzymes recovery time following medication-induced liver injury:
- Generally, liver enzymes start to lower immediately after stopping the offending drug.
- The time liver enzymes take to lower range from a few days to a week from stopping the offending drugs (reference).
- Sometimes, The recovery time is faster, as with Paracetamol (acetaminophen) and Niacin.
- The hepatocellular pattern of injury (elevated ALT and AST) tends to recover faster than the cholestatic pattern.
- In most cases, The injury doesn’t fully resolve for several weeks or months (during this period, the liver enzymes lower to a near-normal value).
- Some medications may cause chronic elevation of the liver enzymes and may end in liver cirrhosis (liver cell failure).
3. Alochol-Induced elevated liver enzymes.
The time liver enzymes take to recover is determined by whether you continue drinking or not. So, the most important step in lowering your liver enzymes is to stop drinking.
Excessive drinking results in fat accumulation inside the liver cells with subsequent mild elevations of AST, ALT, and GGT liver enzymes.
After stopping Alochol, Your liver enzymes often lower to normal levels within two to three weeks. The hepatic steatosis (fat accumulation) also completely resolves within the same period.
However, advanced liver injury (liver cirrhosis) due to alcohol abuse for years may cause persistent elevations of the liver enzymes.
However, your liver will eventually recover if the damage is not severe (even after years of abuse). So, it is important to work with your doctor to determine the extent of the damage.
4. Nonalcoholic fatty liver disease (NAFLD).
NAFLD (nonalcoholic fatty liver disease) is the most common liver disease in western and industrialized countries (reference).
About 25% (one in every four persons) of the world population has NAFLD.
A subset of NAFLD patients progresses to NASH (Nonalcoholic steatohepatitis). People with NASH may experience elevated liver enzymes for prolonged periods.
Unfortunately, No specific medication can cure NASH or NAFLD completely.
Diet, lifestyle changes, losing weight, and taking supportive liver supplements may help lower the liver enzymes with NASH.
The time liver enzymes take to lower with NASH is highly variable. Most people take several months to recover the elevated enzymes. Others fail to achieve normal liver enzymes.
The most important lines to normalize liver enzymes with NASH are:
- Weight loss is the most critical step to lowering liver enzymes and improving NASH. Some studies found that losing at least 5% of body weight will improve hepatic steatosis and lower liver enzymes.
- Vitamin E supplementation.
- Diabetes control (for people with DM).
- Diet and exercise.