A liver function panel with proper interpretation — mildly abnormal liver tests are common and rarely serious.
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Liver function tests measure enzymes and proteins that indicate how the liver is working, and whether its cells are under strain.
The name is slightly misleading. Most of what is measured reflects liver damage rather than liver function — and the liver is remarkably good at continuing to work while quietly sustaining it. Abnormal results are common, usually mild, and often have a straightforward explanation. Normal results do not entirely exclude liver disease.
ALT and AST — enzymes released when liver cells are damaged. The ratio between them is informative: ALT higher than AST suggests fatty liver, which is now the commonest cause of abnormal liver tests in the UK. AST higher than ALT, particularly at a ratio around 2:1, points more towards alcohol.
GGT — the marker that most often clarifies an unclear picture. It rises with alcohol and with bile duct problems, so a raised ALP with a raised GGT points to the biliary system, whereas raised ALP with a normal GGT usually points to bone rather than liver at all.
ALP — raised in bile duct obstruction, but also in bone disease, pregnancy and normal adolescent growth.
Bilirubin — the pigment causing jaundice when it accumulates. A mildly raised bilirubin with otherwise normal results is frequently Gilbert's syndrome, a harmless inherited variation affecting around 1 in 20 people that needs recognising rather than investigating repeatedly.
Albumin — a protein the liver makes, and one of the few genuine measures of function. It falls in longstanding liver disease.
Ferritin — included because it is raised in haemochromatosis, an inherited iron-overload condition that damages the liver and is treatable when found early.
Included: alanine aminotransferase (ALT) · alkaline phosphatase (ALP) · aspartate aminotransferase (AST) · gamma-glutamyltransferase (GGT) · total bilirubin · albumin · ferritin.
GGT is the one that most often clarifies things, because it separates an alcohol-related pattern from other causes.
1. Consultation. Alcohol, medication, weight and family history all change how the result should be read, so the history comes first.
2. Referral. To a Randox Health clinic. We commonly request HbA1c and lipids alongside, because fatty liver travels with insulin resistance and rarely occurs in isolation.
3. The sample. A single blood draw. Fasting is preferred, and avoid alcohol for at least 48 hours and strenuous exercise for 24 hours beforehand — both raise enzyme levels and can produce an abnormal result that means nothing.
4. Results review. A GP explains the pattern rather than the individual numbers. Mildly abnormal liver tests usually need repeating rather than panicking about, and where they persist we arrange ultrasound or hepatology referral.
Fasting is preferred. Avoid alcohol for at least 48 hours and strenuous exercise for 24 hours beforehand, as both raise enzyme levels.
ALT and AST come from liver cells. Raised levels mean cells are being damaged — most often by fat, alcohol, medication or a virus.
ALP and GGT relate to the bile ducts. Raised together they point towards a bile duct problem; ALP raised alone is frequently coming from bone rather than liver, which is a common source of confusion.
GGT is the one that most often clarifies things. Raised alongside ALT, it points towards alcohol. Normal GGT with raised ALT points away from it.
Fatty liver, by a wide margin. Non-alcoholic fatty liver disease is now the commonest liver abnormality in the UK, it is closely tied to weight and insulin resistance, and it is reversible in its early stages.
That is the useful part: a mildly abnormal liver test in someone carrying extra weight is not usually a disaster — it is an early warning with something you can actually do about it.
The enzymes measure damage; albumin and bilirubin measure how well the liver is working. A liver can be inflamed with entirely normal function, which is the usual situation.
Gilbert's syndrome is worth knowing about: an isolated raised bilirubin with everything else normal, present in around one person in twenty, entirely harmless, lifelong, and frequently causing unnecessary alarm. It rises with fasting and illness, which is when people notice it.
Alcohol in the previous 48 hours, strenuous exercise in the previous 24 — which raises AST from muscle rather than liver — and recent illness. Testing after a heavy weekend gives a result that reflects the weekend.
Where fatty liver is likely, a fibrosis score — FIB-4 or an ELF test — estimates scarring far better than ALT does. These are calculated or measured separately, and they are what determine whether someone needs hepatology assessment.
That is the question that actually matters — not whether the ALT is 45 or 60, but whether the liver is scarring.
A slightly raised ALT is found in a large proportion of the adult population, and the great majority of it is fatty liver. The right response is usually to address weight, alcohol and blood sugar and repeat in three to six months — not to scan immediately or panic.
Liver function testing is free on the NHS with relevant symptoms or on medicines requiring monitoring — methotrexate, statins, some epilepsy drugs. If you are on one of those, this monitoring should already be happening.
Liver "detox" and cleanse products, milk thistle, and "liver support" supplements. None has convincing evidence, and several herbal products — including some bodybuilding and weight-loss supplements — are a recognised cause of genuine liver injury.
Repeat scanning of a mildly fatty liver without a fibrosis assessment, which answers a question nobody asked.
Usually not, and usually reversible. The commonest cause by a wide margin is fatty liver, which is tied to weight, alcohol and insulin resistance.
It is better understood as an early warning than a diagnosis — and it is one of the few abnormal results where what you do next genuinely changes the outcome.
Not necessarily, and this is worth being clear about. Liver function tests can be entirely normal in established cirrhosis, because the enzymes fall as the liver runs out of cells to damage.
Where scarring is the question, a fibrosis score is the right test, not another set of enzymes.
Considerably, and for longer than people expect. Avoid alcohol for at least 48 hours before the test — a heavy weekend produces a result that reflects the weekend rather than your liver.
GGT is the marker most sensitive to alcohol, which is why it is included.
Because AST comes from muscle as well as liver. A hard session in the previous 24 hours raises it, and can make a normal liver look abnormal.
That is very likely Gilbert's syndrome — present in around one person in twenty, entirely harmless, lifelong, and requiring no treatment at all.
It rises with fasting, illness and stress, which is usually when people notice it. It is worth knowing you have it, because it explains a result that otherwise causes repeated alarm.
Fat accumulating in liver cells — now the commonest liver abnormality in the UK, closely linked to weight, blood sugar and cholesterol.
In its early stages it is reversible. A minority progress to scarring, which is why the fibrosis question matters more than the enzyme number.
Weight loss of around 7–10% is the treatment with the best evidence, and it works.
Statins — mild rises are common and rarely a reason to stop. Methotrexate, some epilepsy medicines, and antibiotics including co-amoxiclav and flucloxacillin.
And supplements, which people rarely mention — some bodybuilding, weight-loss and herbal products are a recognised cause of serious liver injury. Tell us everything you take.
Often yes for a persistently abnormal result — an ultrasound identifies fatty liver, gallstones and structural problems.
But a scan does not answer the scarring question, which is what determines whether you need specialist assessment. A fibrosis score does.
No convincing evidence, and a genuine risk. Several herbal and bodybuilding supplements cause liver injury — which is an unfortunate irony for products sold as liver support.
What works is weight, alcohol and blood sugar.
Not on your own. Mild enzyme rises on a statin are common and rarely require stopping, and the cardiovascular benefit usually outweighs it comfortably.
Significant rises do need reviewing — which is why liver function is checked at baseline and at three months.
Clinically reviewed by Dr Mohammad Zubair Khan, GMC 7563469
Last reviewed
August 23, 2026
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