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Decoding Your Liver Function Tests (LFTs)

PBTT

Private Blood Tests Team

Clinical Team

29 Dec 202510 min read

Your liver is one of the hardest-working organs in your body, performing over 500 vital functions every day. From filtering toxins and metabolising medications to producing proteins and storing energy, the liver is essential for life. Liver function tests (LFTs) are a group of blood tests that help assess how well your liver is working and can detect early signs of liver damage or disease.

Understanding your LFT results empowers you to take proactive steps toward protecting your liver health. This guide breaks down each component of a liver function test panel and explains what your results may mean.

What Are Liver Function Tests?

Liver function tests, also called a hepatic panel or liver panel, measure various enzymes, proteins, and substances in your blood that are produced by or processed by the liver. Despite the name, LFTs do not directly measure liver "function" – rather, they detect markers that indicate liver cell damage, inflammation, or problems with bile flow.

A standard LFT panel typically includes:

  • Alanine aminotransferase (ALT)
  • Aspartate aminotransferase (AST)
  • Alkaline phosphatase (ALP)
  • Gamma-glutamyl transferase (GGT)
  • Bilirubin (total and direct)
  • Albumin
  • Total protein
  • Let us examine each of these markers in detail.

    ALT (Alanine Aminotransferase)

    ALT is an enzyme found primarily in liver cells. When liver cells are damaged or inflamed, ALT leaks into the bloodstream, causing elevated levels. ALT is considered the most specific marker for liver damage because it is found mainly in the liver.

    Normal range: 7-56 U/L (varies by laboratory)

    Optimal for longevity: Below 25 U/L for men, below 20 U/L for women

    Elevated ALT may indicate:

  • Non-alcoholic fatty liver disease (NAFLD)
  • Alcoholic liver disease
  • Viral hepatitis (A, B, C)
  • Medication-induced liver injury
  • Autoimmune hepatitis
  • Liver cirrhosis
  • AST (Aspartate Aminotransferase)

    AST is another enzyme released when liver cells are damaged. However, AST is also found in the heart, muscles, kidneys, and brain, making it less specific to the liver than ALT. The ratio of AST to ALT can provide additional diagnostic information.

    Normal range: 10-40 U/L (varies by laboratory)

    AST:ALT ratio significance:

  • Ratio less than 1: Suggests non-alcoholic fatty liver disease or viral hepatitis
  • Ratio greater than 2: Suggests alcoholic liver disease
  • Ratio greater than 1 with both elevated: May indicate cirrhosis
  • Elevated AST may indicate:

  • Liver disease (when elevated alongside ALT)
  • Heart attack or muscle damage (if AST elevated but ALT normal)
  • Strenuous exercise
  • ALP (Alkaline Phosphatase)

    ALP is an enzyme found in the liver, bones, kidneys, and intestines. In the context of liver health, elevated ALP typically indicates problems with bile flow (cholestasis) rather than direct liver cell damage.

    Normal range: 44-147 U/L (varies by age and sex)

    Elevated ALP may indicate:

  • Bile duct obstruction (gallstones, tumours)
  • Primary biliary cholangitis
  • Liver cancer or metastases
  • Bone disorders (Paget's disease, bone fractures)
  • Pregnancy (ALP rises normally during pregnancy)
  • When ALP is elevated, GGT testing helps determine whether the source is liver or bone – if GGT is also elevated, the liver is likely the source.

    GGT (Gamma-Glutamyl Transferase)

    GGT is an enzyme found in the liver and bile ducts. It is particularly sensitive to alcohol consumption and is often elevated even with moderate drinking. GGT is also a useful marker of oxidative stress.

    Normal range: 9-48 U/L for men, 9-36 U/L for women

    Optimal for health: Below 25 U/L

    Elevated GGT may indicate:

  • Alcohol consumption (even moderate amounts)
  • Fatty liver disease
  • Bile duct problems
  • Certain medications
  • Pancreatic disease
  • Heart disease (GGT is associated with cardiovascular risk)
  • Bilirubin

    Bilirubin is a yellow pigment produced when red blood cells break down. The liver processes bilirubin and excretes it into bile. Elevated bilirubin causes jaundice – yellowing of the skin and eyes. For more detailed information, read our guide on bilirubin testing.

    Normal ranges:

  • Total bilirubin: 3-21 μmol/L (0.2-1.2 mg/dL)
  • Direct (conjugated) bilirubin: 0-5 μmol/L (0-0.3 mg/dL)
  • Elevated bilirubin may indicate:

  • Liver disease affecting bilirubin processing
  • Bile duct obstruction
  • Haemolytic anaemia (increased red blood cell breakdown)
  • Gilbert's syndrome (a harmless genetic condition)
  • Albumin

    Albumin is the most abundant protein in blood, produced exclusively by the liver. It helps maintain fluid balance in your body and transports various substances. Albumin levels reflect the liver's synthetic (production) capacity.

    Normal range: 35-50 g/L

    Low albumin may indicate:

  • Chronic liver disease or cirrhosis
  • Malnutrition
  • Kidney disease (protein loss)
  • Inflammatory conditions
  • Severe burns or trauma
  • Albumin takes weeks to change, so low levels typically indicate chronic rather than acute liver problems.

    Total Protein

    Total protein measures all proteins in your blood, including albumin and globulins (antibodies and other proteins). It provides additional context for interpreting other LFT results.

    Normal range: 60-83 g/L

    Abnormal total protein may indicate:

  • Liver disease
  • Kidney disease
  • Nutritional deficiencies
  • Immune system disorders
  • Patterns of Liver Test Abnormalities

    Healthcare providers often look at patterns across multiple LFT markers to help identify the underlying cause:

    Hepatocellular pattern (liver cell damage):

  • ALT and AST significantly elevated
  • ALP normal or mildly elevated
  • Suggests hepatitis, fatty liver, or toxic injury
  • Cholestatic pattern (bile flow problems):

  • ALP and GGT significantly elevated
  • ALT and AST normal or mildly elevated
  • Suggests bile duct obstruction or cholestatic liver disease
  • Mixed pattern:

  • All enzymes elevated
  • May indicate drug-induced liver injury or infiltrative diseases
  • Common Causes of Abnormal LFTs

    Many factors can cause abnormal liver function tests:

  • Non-alcoholic fatty liver disease (NAFLD) – The most common cause in Western countries
  • Alcohol consumption – Even moderate drinking can elevate GGT
  • Medications – Paracetamol, statins, antibiotics, and many others
  • Viral hepatitis – Hepatitis B and C can cause chronic elevation
  • Obesity – Strongly associated with fatty liver
  • Diabetes and insulin resistance – Metabolic dysfunction affects the liver
  • Supplements – Some herbal products can be hepatotoxic
  • When to Be Concerned

    Mildly elevated liver enzymes are common and often resolve on their own. However, seek medical advice if:

  • Levels are more than twice the upper limit of normal
  • Elevations persist on repeat testing
  • You have symptoms like jaundice, abdominal pain, or unexplained fatigue
  • You have risk factors for liver disease
  • Supporting Your Liver Health

    To maintain healthy liver function:

  • Limit alcohol – Or abstain completely
  • Maintain a healthy weight – Obesity is a major risk factor for fatty liver
  • Exercise regularly – Helps reduce liver fat
  • Eat a balanced diet – Limit processed foods, sugar, and saturated fat
  • Be cautious with medications – Follow dosing instructions carefully
  • Avoid unnecessary supplements – Some can harm the liver
  • Get vaccinated – Hepatitis A and B vaccines are available
  • Book Your Liver Function Test

    Regular monitoring of your liver health is an important part of preventive healthcare. At Private Blood Tests London, we offer comprehensive liver function testing at our CQC-registered clinic in South Kensington. Our experienced team ensures accurate results delivered quickly and securely.

    Learn more about [liver health and what blood tests reveal](/blog/liver-health-matters-what-blood-tests-can-reveal-about-this-vital-organ), and explore our [liver function test services](/liver-function-test).

    Take charge of your liver health – book your liver function test today.

    Ready to Book Your Test?

    Visit our CQC-registered clinic in South Kensington for professional blood testing services.