High transaminases: is it a liver pathology?

The appearance of elevated transaminase levels is a not uncommon problem in daily clinical practice and is usually the result of some type of inflammation (chronic or acute) in the liver (1).

The aim of the article is to understand the causes of high transaminases in the blood and how to reduce or prevent the occurrence of liver injury.

Additionally, we will present some examples of habits and medical guidelines that can be followed to avoid future pathologies.

What are transaminases?

The liver is one of the most relevant organs in the body and one of the most important when we talk about metabolism. Therefore, an injury to liver cells (hepatocellular injury) must be detected as soon as possible through specific tests (5).

Transaminases are a group of enzymes, specifically alanine aminotransferase (ALT) and aspartate aminotransferase (AST), that are involved in metabolism, and although they are found in different areas of the body (muscle or kidney), the target organ is the liver (1).

These enzymes are especially involved in the transfer reactions of amino groups from an amino acid to a keto acid, which promotes the synthesis of amino acids and keto acids different from the originals. (3)

When liver cells, called hepatocytes, are damaged for some reason, these enzymes enter the bloodstream and can be measured through a blood test, causing the well-known high transaminases.

For this reason, it is very common to determine liver enzymes in routine tests, in medical check-ups conducted in most workplaces, and in blood donations. (2)

What are the normal values of transaminases?

What are the most important transaminases in the liver?

As we mentioned, the most important transaminases in the liver that help diagnose any liver problem are (5):

• Aspartate aminotransferase (or glutamic-oxaloacetic transaminase), also known as AST or GOT; with a half-life of 48 hours.
• Alanine aminotransferase (or glutamic-pyruvic transaminase), also known as ALT or GPT; with an average life of 18 hours.

What can cause the liver to become inflamed?

A specialist doctor in Gastroenterology, Dr. Oreste Lo Iacono, stated that some of the most serious and less common reasons for liver inflammation are:

• Acute viral hepatitis
• Ischemic hepatitis
• Drug or toxin injuries

However, it is proven that more than 80% of adults have high transaminases in the blood and are frequently due to:

• Fat deposits in the liver
• Damage from high alcohol consumption
• Infection by the hepatitis virus

What are the symptoms of high transaminases?

Sometimes, the levels of high transaminases take time to diagnose because they do not produce symptoms like in other diseases, so a diagnosis must be made to determine their concentration.

This reason has been observed in the prevalence rate of fatty liver in obese patients of approximately 38%, while 5% of diagnosed cases correspond to patients with normal weight. (11)

Most often, high transaminases are discovered accidentally when we perform a blood test, either because the doctor has requested it routinely or because the patient is undergoing an examination before an operation for some non-liver disease.

Additionally, high transaminases can also be detected during the follow-up of a pharmacological treatment.

This is because there are drugs with a very high hepatotoxic potential, such as amoxicillin or macrolides, herbal products, as well as the use of sports supplements. (8)

Thanks to the work of Roger Andree, O. and Yessenia Vanessa, S.G. in 2022, among many other works and investigations, we can outline the symptomatology of liver diseases in general (6):

• Swelling of the abdomen and legs.
• Bruising.
• Changes in the color of urine and stools.
• Yellowish skin and eyes.

Initial symptoms include:

• Loss of energy.
• Low appetite.
• Nausea.
• Stomach pain.
• Small, red, spider-shaped blood vessels on the skin.

If liver disease worsens, the symptoms will be:

• Fluid accumulation in the legs and abdomen (ascites).
• Yellow color in the skin, mucous membranes, or eyes (jaundice).
• Redness of the palms of the hands.
• In men, impotence, testicular shrinkage, and breast swelling.
• Tendency to bruise and abnormal bleeding.
• Confusion or thinking problems.
• Pale or clay-colored stools.

For this reason, it is necessary to make an early diagnosis so that we can prevent the progression of a disease through non-invasive methods such as biochemical and serological tests, ultrasounds, Fibroscan, and, only in specific cases, a liver biopsy. (2)

Signs derived from liver damage

• Extreme fatigue
• Fatigue
• Vomiting
• Abdominal pain
• Nausea
• Yellow mucous membranes or jaundice
• Dark urine or choluria
• General itching

Infections and high transaminases

In some infectious processes of a transient nature, high transaminases in the blood can be triggered.

These infections can be both local and systemic, mainly in infants and young children, without exceeding twice the maximum value considered normal.

As an example of these infections, we have respiratory or gastrointestinal ones derived from numerous viruses such as adenovirus or herpesvirus.

Also, urinary infections can occur due to Escherichia coli, mainly in infants, so in these cases, a urine culture should be performed as the main diagnosis. (4)

What type of medical examination detects liver changes?

In the day-to-day clinical practice, the methods to diagnose liver diseases are multiple, and among them, we have (5):

• Tests that detect possible hepatocellular injury or cytolysis.
• Tests related to bilirubin metabolism, also valid for biliary stasis.
• Tests to analyze the liver’s synthesis of vital substances.

High transaminases and physical exercise

It is normal for intense and continuous exercise (exercise or physical activity) to cause high transaminases to be elevated without any apparent explanation.

In that case, all medication that the person is taking should be discontinued (as long as it is unnecessary) and the intensity of the exercise or physical activity should be reduced (3).

In summary, if you have high transaminases:

• Processed or fatty foods should be avoided.
• Increase the consumption of fruits and vegetables.
• Moderate the consumption of alcoholic beverages.
• Avoid sugary products and excessive salt consumption.
• Engage in physical activity daily.
• Drink water regularly to help the liver eliminate fats

Do I have high transaminases, can I consume proteins?

An elevation of the AST/ALP ratio correlates with excessive liver workload, exercise with inappropriate intensity (excessive), high intake of protein supplements, alcohol, or immune system diseases (4).

The dietary recommendations for protein consumption are (3):

• From 1.1 to 1.4 grams per kg of weight for amateur athletes.
• From 1.2 to 1.4 grams per kg of weight for professional competitive athletes.
• Up to 2 grams of protein per kg of weight for bodybuilders.
• Athletes seeking to increase muscle mass, between 1.5 and 2 grams per kg of weight.

The increase in muscle volume for aesthetic reasons is one of the main reasons for dietary modification based on increased proteins. However, this increase can be achieved through diet (meat, fish, dairy, among others) (2).

However, to increase 500 grams of muscle, only about 10-14 additional grams of protein daily would be needed. Supplements provide about 80 grams per serving. This leaves us with about 60-70 grams of excess. More work for the liver (3).

What diseases raise transaminases?

The pathologies linked to high transaminases are as follows (5):

• Hepatitis caused by viruses.
• Cirrhosis (including any etiology).

Also possible explanations for high transaminases (although they occur less frequently) are the following:

• Autoimmune hepatitis.
• Wilson’s disease.
• Celiac disease.
• Alpha-1 antitrypsin deficiency.
• Hemochromatosis.
• Myopathies.
• Intolerance to cow’s milk proteins.

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Bibliographic references

1. Ampurdanès Mingal, S and Bruguera Cortada, M (2000). A patient with prolonged hypertransaminasemia. Integral medicine.
2. Apta vital sport (n.d.). Proteins to gain muscle mass. Some tips.
3. Cobos Lituma, AE (2022). Alterations in transaminase values in athletes consuming protein supplements at the specialized center in sports medicine Asdrubal e la Torre in the years 2015 and 2016. Central University of Ecuador. Final degree project.
4. Díaz Gil, D (2014). High transaminases in fitness. Vitonica.
5. García Martín, M and Zurita Molina, A (2010). Transaminases. Assessment and clinical significance. Diagnostic-therapeutic protocols of pediatric gastroenterology, hepatology, and nutrition SEGHNP-AEP.
6. López Roger Andree, O and Gutiérrez Yesenia Vanessa (2022). Clinical and diagnostic characteristics of liver diseases associated with transaminases and gamma-glutamyl transpeptidase in adults. State University of South Manabí. Final degree project.
7. Esteban, C. F. (2022, May 6). What does it mean to have high transaminases and what are the causes? Business Insider Spain. Retrieved on 11/14/2022.
8. Robles, L. (2016, October 11). Elevated transaminases: Are they always a problem? Surgery specialists. Retrieved on 11/14/2022.
9. Ampurdanès S; M. Bruguera (2000). A patient with prolonged hypertransaminasemia. Elservier. Integral Medicine, 36(4): 129-136.
10. Lesmes L; Albañil M.R. (2013). Isolated increase of transaminases: diagnostic approach. Active Training in Primary Care Pediatrics, 6 (1): 35-42.
11. Schwimmer J, Deutsch R, Kahen T, Lavine J, Stanley C, Behling C. Prevalence of Fatty Liver in Children and Adolescents. Pediatrics. 2006;118:1388-93.

Co-author | Juanma Campos – Read more articles by this author.

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