Does Stress Cause Elevated Liver Enzymes? Exploring the Connection

The liver is responsible for detoxification, digestion, and metabolism. One of the key indicators of liver health is enzyme levels—such as ALT, AST, ALP, and GGT—measured through routine blood tests. Elevated levels often signal inflammation or liver dysfunction, but what if the underlying cause isn’t alcohol, fatty liver disease, or infection? Could stress be a contributing factor?

Stress is widely recognized for its effects on mood, sleep, and digestion, but its impact on liver function is less commonly discussed. If you’ve recently received abnormal liver enzyme results and are experiencing high stress or anxiety, it’s worth exploring whether stress could be influencing your liver health.

How Stress Influences Liver Enzyme Levels

When faced with stress, the body activates the "fight-or-flight" response, releasing stress hormones such as cortisol and adrenaline. While this response is beneficial in short bursts, chronic stress can lead to persistent hormone imbalances and inflammation. The liver plays a crucial role in processing these hormones, and prolonged stress can contribute to enzyme fluctuations.

Emerging research suggests that chronic stress promotes oxidative stress and inflammation within the liver, potentially impairing its normal function. A 2022 study found that individuals with longer working hours had significantly elevated ALT and AST enzymes compared to those with lower stress levels, indicating that stress-induced liver inflammation may be more common than previously thought.

Is Stress-Related Liver Enzyme Elevation Common?

Stress-related liver enzyme elevation is often overlooked because liver dysfunction is more commonly linked to diet, alcohol consumption, or infections. However, studies indicate that individuals with high stress or anxiety disorders frequently exhibit abnormal liver function tests. This highlights the importance of addressing mental well-being as part of overall liver health.

To differentiate stress-related liver enzyme elevations from liver disease, healthcare providers review patient history, lifestyle factors, and additional diagnostic tests. If no liver-specific conditions are identified, stress may be a significant factor.

The Link Between Anxiety and Liver Enzyme Levels

Anxiety can trigger a prolonged stress response, keeping the body in a heightened state of alertness and leading to frequent releases of cortisol and adrenaline. Over time, elevated stress hormones may contribute to metabolic changes and inflammation, which can impact liver function and, in some cases, influence enzyme levels. However, stress alone is not a primary cause of liver enzyme elevation.

Moreover, chronic anxiety often contributes to behaviors that negatively impact liver health like poor sleep, lack of exercise, and increased alcohol or medication use. Addressing anxiety may therefore be an essential step in normalizing liver enzyme levels.

How Chronic Stress Affects Liver Function Tests

Liver function tests measure enzyme levels, including ALT and AST, to assess liver health. Chronic stress may contribute to mild enzyme elevations, possibly through inflammatory and metabolic changes, but it does not typically mimic the patterns seen in liver diseases.

The key difference is reversibility—if stress is the main factor, enzyme levels often return to normal with effective stress management. However, prolonged stress exposure may contribute to metabolic conditions that increase the risk of long-term liver dysfunction if left unaddressed.

Diagnosing Stress-Related Liver Enzyme Elevation

Doctors diagnose liver enzyme elevations through blood tests measuring:

• ALT (Alanine Aminotransferase)
• AST (Aspartate Aminotransferase)
• ALP (Alkaline Phosphate)
• GGT (Gamma-Glutamyl Transferase)

If abnormalities are detected, further testing is conducted to rule out conditions such as hepatitis, fatty liver disease, and bile duct disorders. If no underlying liver disease is found and a patient reports significant stress or anxiety, stress-related liver enzyme elevation may be considered a potential cause. Addressing both physical and mental health is essential for accurate diagnosis and effective treatment.

Managing Stress-Related Liver Enzyme Elevations

The good news is that stress-related liver enzyme elevations are often reversible with targeted lifestyle changes. Prioritizing stress management can significantly improve liver function. Effective strategies include regular exercise to help regulate cortisol levels and reduce inflammation and deep breathing techniques to promote relaxation and lowers stress hormones.

Dietary support is equally important. Consider incorporating:

• Antioxidant-rich foods – Such as berries, leafy greens, and nuts
• Healthy fats – Like avocados, olive oil, and fatty fish
• Hydration – Drinking plenty of water to support detoxification

Additionally, reducing alcohol intake and limiting processed foods can further aid enzyme normalization.

Monitoring Liver Enzyme Levels at Home

Keeping track of liver health is crucial, especially if you experience chronic stress. At-home liver test kits, such as those offered by Ribbon, provide a convenient way to monitor enzyme levels from the comfort of your home. Ribbon’s test kits allow you to track fluctuations in ALT, AST, and other key markers, empowering you to take proactive steps toward better liver health.

If stress is a concern, using an at-home liver test kit can help you assess whether lifestyle changes are making a difference. Regular monitoring ensures that enzyme levels are stable and helps you determine when professional medical guidance is necessary.

Conclusion

If you've been experiencing persistent stress and recently discovered elevated liver enzymes, it’s important to take a holistic approach. While stress can impact liver function, these effects are often reversible with proactive lifestyle adjustments. Incorporating stress management techniques, maintaining a liver-supportive diet, and monitoring enzyme levels with at-home liver test kits from Ribbon can make a meaningful difference in overall health.

For individuals with consistently high enzyme levels despite lifestyle changes, consulting a healthcare provider is essential to rule out underlying conditions. Your liver works tirelessly to keep you healthy—support it by managing stress and fostering its natural resilience.

References:

De Nys, L., Anderson, K., Ofosu, E. F., Ryde, G. C., Connelly, J., & Whittaker, A. C. (2022). The effects of physical activity on cortisol and sleep: A systematic review and meta-analysis. Psychoneuroendocrinology, 143, 105843. https://doi.org/10.1016/j.psyneuen.2022.105843

Harvard Health. (2024, April 3). Understanding the stress response. https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response

Joung JY, Cho JH, Kim YH, Choi SH, Son CG. A literature review for the mechanisms of stress-induced liver injury. Brain Behav. 2019 Mar;9(3):e01235. doi: 10.1002/brb3.1235. Epub 2019 Feb 13. PMID: 30761781; PMCID: PMC6422711.

Kennedy, E., & Niedzwiedz, C. L. (2021). The association of anxiety and stress-related disorders with C-reactive protein (CRP) within UK Biobank. Brain Behavior & Immunity - Health, 19, 100410. https://doi.org/10.1016/j.bbih.2021.100410

Lala V, Zubair M, Minter DA. Liver Function Tests. [Updated 2023 Jul 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482489/

Liu, Y. Z., Wang, Y. X., & Jiang, C. L. (2017). Inflammation: The Common Pathway of Stress-Related Diseases. Frontiers in human neuroscience, 11, 316. https://doi.org/10.3389/fnhum.2017.00316

Nikolic, A., Fahlbusch, P., Riffelmann, N., Wahlers, N., Jacob, S., Hartwig, S., Kettel, U., Schiller, M., Dille, M., Al-Hasani, H., Kotzka, J., & Knebel, B. (2024). Chronic stress alters hepatic metabolism and thermodynamic respiratory efficiency affecting epigenetics in C57BL/6 mice. iScience, 27(3), 109276. https://doi.org/10.1016/j.isci.2024.109276

Song, J. H., Kim, H. R., Lee, D. W., Min, J., Lee, Y. M., & Kang, M. Y. (2022). Association between long working hours and liver enzymes: evidence from the Korea National Health and Nutrition Examination Survey, 2007-2017. Annals of occupational and environmental medicine, 34, e9. https://doi.org/10.35371/aoem.2022.34.e9