Long COVID and Liver Health: What You Need to Know About Liver Enzymes
If you’ve been grappling with the ongoing mystery of Long COVID, you’re not alone. You’ve probably noticed it can affect far more than your lungs, it can impact your liver too.
Emerging research, much of it observational, is exploring the link between Long COVID and liver function, particularly liver enzyme levels.
So, what does this mean for you? Should you be concerned about your liver, and what steps can you take to protect it?
Liver Enzymes: What Are They and Why Do They Matter?
Your liver is a multitasking powerhouse detoxifying harmful substances, producing essential proteins, and helping process fats. It uses enzymes to carry out these vital tasks.
When something’s wrong, those enzymes can become elevated, acting as a warning sign. The most common ones to monitor are:
- ALT (alanine aminotransferase)
- AST (aspartate aminotransferase)
- ALP (alkaline phosphatase)
- GGT (gamma-glutamyl transferase)
Elevated levels may indicate liver stress or damage.
The Link Between Long COVID and Liver Function
Observational studies show that some people with Long COVID have elevated liver enzymes, suggesting the liver may be involved in the longer-term effects of the virus.
One study published in The Lancet found liver injury can occur in certain individuals after recovering from the acute phase of COVID. Even those without pre existing liver conditions have shown signs of liver dysfunction months later.
Elevated enzymes don’t always mean permanent damage. Often, they simply reflect liver strain from inflammation or metabolic changes.
Why Might Long COVID Affect the Liver?
1. Inflammation Overdrive
When the immune system is in high alert mode, systemic inflammation can occur, putting extra strain on the liver.
2. The Post-Viral Recovery Phase
After viral infections, the body needs time to detoxify. The liver works to clear leftover viral material, which may temporarily elevate enzyme levels.
3. Fatty Liver Development
Some Long COVID patients develop non-alcoholic fatty liver disease (NAFLD), where excess fat accumulates in the liver. This can cause mild enzyme elevations and is often linked with metabolic disruption.
4. Clotting and Hormones
The liver also makes proteins that help your blood clot and breaks down certain hormones. If it’s stressed by Long COVID, this could influence clotting or hormone balance, which may contribute to fatigue, bruising, or mood and energy changes.
What the Research Says
A review in Hepatology noted that while acute liver injury during COVID-19 is uncommon, post-viral enzyme elevations are more frequent in Long COVID.
Another Frontiers in Medicine study reported around 25% of people with Long COVID had raised liver enzymes (especially ALT and AST) months after infection. Immune responses may inadvertently affect the liver, particularly in those with pre-existing metabolic conditions.
Much of this evidence is observational, showing patterns rather than definitive cause and effect.
Other Factors That Can Affect the Liver in Long COVID
Many people with Long COVID take regular medications for symptom relief painkillers, anti-inflammatories, stomach acid reducers, antihistamines, or sleep aids along with supplements like vitamin D, omega-3, magnesium, or herbal products.
Even if each is safe alone, the combined load can stress the liver, especially if used over months.
Tips:
- Keep a full list of everything you take and share it with your GP.
- Avoid starting new supplements without checking interactions.
Skin Clues That Your Liver Might Be Stressed
Sometimes, the first signs of liver strain appear on the skin:
- Small, bright red spots (spider angiomas).
- Itching with no clear rash.
- Yellowing of the skin or eyes (jaundice).
- Unexplained bruising.
If you notice these changes, it’s best to have your liver function checked.
Supporting Liver Health After Long COVID
1. Monitor Your Liver Enzymes
Periodic blood tests can track liver health. Your GP can guide the frequency and interpretation.
2. Eat a Liver-Friendly Diet
Include antioxidant-rich foods: berries, leafy greens, cruciferous vegetables (broccoli, Brussels sprouts). Avoid refined carbs and excess sugar to reduce liver strain.
3. Stay Hydrated
Adequate water intake supports the liver’s detoxification processes.
4. Exercise Gently if you can
Light to moderate activity can improve liver health and reduce fat accumulation. For Long COVID fatigue or post-exertional malaise, pace yourself and evaluate the activity you can safely manage.
5. Avoid Alcohol
Alcohol increases liver workload and can worsen inflammation.
6. Supplements (with medical supervision)
Some evidence suggests milk thistle and N-acetylcysteine (NAC) may protect liver cells. Always consult your healthcare provider before starting supplements.
The Takeaway
Long COVID can affect the liver in some people, usually through mild, reversible enzyme elevations. Most cases improve with monitoring, healthy diet, hydration, gentle activity, and moderation in alcohol and medications.
Disclaimer: This article is for information only and is not medical advice. Always speak to your GP or specialist before making changes to your health plan, medications, or supplements.
Long Covid Journey 