Why is my ggt high or low?

The ggt results are interpreted along with the results for total protein, ast sgot, alt sgpt, globulin, alp, bilirubin and ldh to help diagnose disease severity. So let's know about all these tests and let's try to know the real cause of your disease.

After reading this article thoroughly you will be able to self-diagnose your disease

Before understanding about these liver enzymes, let us know about some of the causes of abnormal liver enzymes

Liver enzymes can be abnormal due to:

  • Drinking alcohol
  • Hepatitis A
  • Heart failure
  • Hepatitis B
  • Liver cancer
  • Hepatitis C
  • Celiac disease
  • Metabolic syndrome.
  • Cytomegalovirus (CMV) infection
  • Hemochromatosis
  • Nonalcoholic fatty liver disease
  • Obesity
  • Toxic hepatitis
  • Thyroid disorders

If you need our help diagnosing the severity of your illness and want to get your liver enzymes back to normal, you can upload your blood report here. Upload blood test report now

Alanine aminotransferase (ALT)

A very high level of ALT is frequently seen with acute hepatitis. Moderate increases may be seen with chronic hepatitis. People with blocked bile ducts, cirrhosis, and liver cancer may have ALT concentrations that are only moderately elevated or close to normal.

ALT is commonly measured clinically as part of liver function tests and is a component of the AST/ALT ratio. When used in diagnostics, it is almost always measured in international units/liter (IU/L) or µkat. While sources vary on specific reference range values for patients, 0-40 IU/L is the standard reference range for experimental studies.

Significantly elevated levels of ALT (SGPT) often suggest the existence of other medical problems such as viral hepatitis, diabetes, congestive heart failure, liver damage, bile duct problems, infectious mononucleosis, or myopathy, so ALT is commonly used as a way of screening for liver problems. Elevated ALT may also be caused by dietary choline deficiency.

When elevated ALT levels are found in the blood, the possible underlying causes can be further narrowed down by measuring other enzymes. For example, elevated ALT levels due to hepatocyte damage can be distinguished from bile duct problems by measuring alkaline phosphatase. Also, myopathy-related elevations in ALT should be suspected when the aspartate transaminase (AST) is greater than ALT; the possibility of muscle disease causing elevations in liver tests can be further explored by measuring muscle enzymes, including creatine kinase.

Alkaline phosphatase (ALP)

ALP may be significantly increased with obstructed bile ducts, cirrhosis, liver cancer, and also with bone disease.

Aspartate aminotransferase (AST)

A very high level of AST is frequently seen with acute hepatitis. AST may be normal to moderately increased with chronic hepatitis. In people with blocked bile ducts, cirrhosis, and liver cancer, AST concentrations may be moderately increased or close to normal. When liver damage is due to alcohol, AST often increases much more than ALT (this is a pattern seen with few other liver diseases). AST is also increased after heart attacks and with muscle injury.

AST is similar to alanine transaminase (ALT) in that both enzymes are associated with liver parenchymal cells. The difference is that ALT is found predominantly in the liver, with clinically negligible quantities found in the kidneys, heart, and skeletal muscle, while AST is found in the liver, heart (cardiac muscle), skeletal muscle, kidneys, brain, and red blood cells.

As a result, ALT is a more specific indicator of liver inflammation than AST, as AST may be elevated also in diseases affecting other organs, such as myocardial infarction, acute pancreatitis, acute hemolytic anemia, severe burns, acute renal disease, musculoskeletal diseases, and trauma

If you need our help diagnosing the severity of your illness and want to get your liver enzymes back to normal, you can upload your blood report here. Upload blood test report now


Bilirubin is increased in the blood when too much is being produced, less is being removed, due to bile duct obstructions, or to problems with bilirubin processing. It is not uncommon to see high bilirubin levels in newborns, typically 1 to 3 days old.

The bilirubin level found in the body reflects the balance between production and excretion. Blood test results are advised to always be interpreted using the reference range provided by the laboratory that performed the test. The SI units are μmol/L.

Hyperbilirubinemia is a higher-than-normal level of bilirubin in the blood.

Mild rises in bilirubin may be caused by:

  • Hemolysis or increased breakdown of red blood cells
  • Rotor syndrome

Moderate rise in bilirubin may be caused by:

  • Pharmaceutical drugs
  • Drugs such as protease inhibitors like Indinavir
  • Hepatitis (levels may be moderate or high)

Very high levels of bilirubin may be caused by:

  • Neonatal hyperbilirubinemia
  • Unusually large bile duct obstruction, e.g. stone in common bile duct, tumour obstructing common bile duct etc.
  • Crigler–Najjar syndrome
  • DubinJohnson syndrome
  • Severe liver failure
  • Choledocholithiasis.

Lactate dehydrogenase (LD)

This is a non-specific marker of tissue damage. It is usually not elevated with most liver diseases, but it may be elevated with very acute liver disease or liver tumors. It is also elevated with a number of other conditions that do not affect the liver.

Elevated serum levels of LDH have been observed in a variety of disease states. The highest levels are seen in patients with megaloblastic anemia, disseminated carcinoma, and shock. Moderate increases occur in muscular disorders, renal diseases, and cirrhosis. Mild increases in LDH activity have been reported in cases of myocardial or pulmonary infarction, leukemia, hemolytic anemia, and nonviral hepatitis.

An elevated level of LD may be seen with:

  • Hemolytic anemia
  • Infectious mononucleosis
  • Sepsis
  • Intestinal, myocardial and lung infarction
  • Lymphoma
  • Acute kidney disease
  • Meningitis
  • Acute liver disease
  • Pancreatitis
  • Encephalitis
  • Bone fractures
  • Testicular cancer
  • Severe shock
  • Acute muscle injury
  • Lack of oxygen (hypoxia)


Albumin is often normal in liver disease but may be low due to decreased production, especially in liver cirrhosis.

Low albumin (hypoalbuminemia) may be caused by liver disease, nephrotic syndrome, burns, protein-losing enteropathy, malabsorption, malnutrition, late pregnancy, artefact, genetic variations and malignancy.

High albumin (hyperalbuminemia) is almost always caused by dehydration. In some cases of retinol (Vitamin A) deficiency, the albumin level can be elevated to high-normal values (e.g., 4.9 g/dL) because retinol causes cells to swell with water. (This is also the reason too much Vitamin A is toxic.)

Hypoalbuminemia means low blood albumin levels. This can be caused by:

  • Liver disease
  • Excess excretion by the kidneys
  • Excess loss in bowel
  • Acute disease states
  • Malnutrition
  • Mutation causing analbuminemia
  • Anorexia nervosa
  • Burns

Total protein (TP)

Total protein is typically normal with liver disease. The total protein test measures the total amount of two classes of proteins found in the fluid portion of your blood. These are albumin and globulin.

Proteins are important parts of all cells and tissues.

Albumin helps prevent fluid from leaking out of blood vessels.

Globulins are an important part of your immune system.

Concentrations below the reference range usually reflect low albumin concentration, for instance in liver disease or acute infection. Rarely, low total protein may be a sign of immunodeficiency. Concentrations above the reference range are found in paraproteinaemia, Hodgkin's lymphoma, leukaemia or any condition causing an increase in immunoglobulins.

Gamma-glutamyl transferase (GGT)

A GGT test may be used to help determine the cause of an elevated ALP. Both ALP and GGT are elevated in bile duct and liver disease, but only ALP will be elevated in bone disease. Increased GGT levels are also seen with alcohol consumption and with conditions, such as congestive heart failure.

GGT is predominantly used as a diagnostic marker for liver disease. Latent elevations in GGT are typically seen in patients with chronic viral hepatitis infections often taking 12 months or more to present. Elevated serum GGT activity can be found in diseases of the liver, biliary system, pancreas and kidneys.

More recently, slightly elevated serum GGT has also been found to correlate with cardiovascular diseases and is under active investigation as a cardiovascular risk marker.

Numerous drugs can raise GGT levels, including barbiturates and phenytoin. GGT elevation has also been occasionally reported following nonsteroidal anti-inflammatory drugs (including aspirin). Elevated levels of GGT can also be due to congestive heart failure.

The GGT test is sometimes used to help detect liver disease and bile duct obstructions. It is usually ordered in conjunction with or as follow up to other liver tests such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), ALP, and bilirubin. In general, an increased GGT level indicates that the liver is being damaged but does not specifically point to a condition that may be causing the injury.

If you need our help diagnosing the severity of your illness and want to get your liver enzymes back to normal, you can upload your blood report here. Upload blood test report now

Dr. Dwayne Michaels
Guest Author
Dr. Dwayne Michaels
Guest Author