Liver Enzyme Tests Are Not Reliable in Diagnosing Alcoholic Liver Disease

Gillian May
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Many people are confused about the diagnosis and prevention of alcoholic liver disease (ALD). As with other conditions, people believe that blood tests can detect an abnormality that can help doctors and patients understand the development of the disease. In the case of alcoholic liver disease, blood tests can be very confusing. Even though people may ask for blood tests to understand their liver functioning, these tests may not be that helpful. As a former nurse and recovering alcoholic who lost her father to ALD, I’d like to explain more about this as most people think that these blood tests are definitive when they’re not.

In particular, doctors often will order the liver enzyme test to see how well the liver is functioning. Often people think that this test is definitive, but it’s not. Unfortunately, liver enzymes go up and down rather rapidly. If liver enzymes are raised, it shows that active liver inflammation was happening when the test was taken. For those who drink heavily, a liver enzyme test may show an elevated result. However, if the test was retaken just a few days later, it may indicate a normal result as the liver is at making a quick recovery.

Often, as in the case of heavy drinkers with a potential for ALD, liver enzyme tests can be normal. This gives the patient and the doctor a false sense of security around the health of the liver. In a way, a positive test can be beneficial as it gives a clue to the liver’s health and the patient and doctor are better equipped to talk about prevention and harm reduction.

What this means is that relying on a liver enzyme test may not be the best thing. The liver is a very forgiving organ, and even though it may be struggling, it can often show normal liver enzyme tests in the blood.

A better way to gauge the liver’s health is to conduct a liver scan and perhaps a biopsy if the doctor deems it necessary. Also, blood tests such as bilirubin and albumin give a better clue about liver functioning. However, none of these tests will happen if the doctor doesn’t have a complete medical history that includes the exact amount of alcohol a person drinks per week. If you drink heavily and want to understand your risk for alcoholic liver disease, it’s best to go to your doctor, explain how much you drink, and ask for more stringent testing.

Often liver enzyme tests are done as part of a routine physical. Again, while the results can be helpful, it’s not enough to diagnose potential liver disease in people who drink heavily. This information is essential for people to understand because often, heavy drinkers believe these blood tests are more telling than they are. Often, heavy drinkers are not given the information they need to get help before it’s too late. The more we educate people about alcoholic liver disease, the more people can make better decisions about their health and prevent serious repercussions.

My father thought his liver was okay because the “blood tests” didn’t show anything. Little did he know that his liver was severely scarred and not doing well. My hope in getting this information out is that others won’t face the same fate as my father.

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I'm a former nurse turned freelance writer. I have extensive experience in administration, frontline care, and education in mental health, public health, and geriatrics. However, after 20 years, I needed a change and always wanted to write. I have personal and family experience in mental health and addictions, so I'm passionate about advocacy and education in those areas. I'm also a traveler, photographer, and artist. I funnel all my various expertise into my writing and hope to provide valuable content that is entertaining and educational. Join my email list if you want to read more of my work -


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