What Heavy Drinking Does to Your Liver – If Your γ-GTP Is High

For those who have been flagged for high γ-GTP in their health check-up: An honest discussion about alcohol and your liver

Have you been told your γ-GTP is high in a health check-up, but think, "I don't have any symptoms, so it's probably fine"? The liver is often called the "silent organ" because symptoms usually don't appear until significant damage has accumulated. That's why being flagged by health check-up results is your chance to take action.

Halu Clinic is located about 1-2 minutes on foot from Jujo Station on the JR Saikyo Line, and is open every day from 9 AM to 9 PM, including weekends and holidays. As an internal medicine clinic, we regularly receive consultations from people who are concerned about their liver health after a check-up or who drink frequently and wonder if it's okay. Please feel free to visit us from the Akabane, Higashi-Jujo, Oji, and Itabashi areas.

What exactly is γ-GTP?

γ-GTP (gamma-glutamyl transpeptidase) is an enzyme found in high concentrations in the liver, bile ducts, and kidneys. It is involved in the metabolism of alcohol and drugs, as well as bile flow.

If there is any damage to the liver or bile ducts, this enzyme leaks into the bloodstream and its levels rise. It is particularly known to be high in people who drink a lot of alcohol, and is often a focus in health check-ups as an "indicator of alcohol consumption."

The normal range is generally considered to be below 50 IU/L for men and below 30 IU/L for women, but these are just guidelines; the higher the value, the higher the risk.

What happens to your liver if you drink too much?

Alcohol is absorbed through the stomach and small intestine, and most of it is processed by the liver. The liver breaks down alcohol into a toxic substance called acetaldehyde, which is then further detoxified into acetic acid, then water and carbon dioxide. The liver single-handedly undertakes this entire process.

If you drink too much, your liver cannot process it all, and its cells continue to be damaged. Alcoholic liver disease progresses in the following stages:

① Fatty Liver

This is a condition where neutral fats accumulate in liver cells. It is often seen in people who drink a lot, but there is also "non-alcoholic fatty liver disease (NAFLD)" which can occur even in non-drinkers due to obesity or overeating. At this stage, there are usually no symptoms, and it is often discovered for the first time through health check-up results. This is a stage where improvement may be possible by stopping or reducing alcohol consumption.

② Alcoholic Hepatitis

If heavy drinking continues, inflammation occurs in the liver. AST (GOT), ALT (GPT), and γ-GTP levels significantly increase. Symptoms such as fatigue, loss of appetite, and discomfort in the right side of the abdomen may appear. In severe cases, hospitalization may be required.

③ Cirrhosis

As a result of prolonged inflammation, liver cells become fibrous (harden). Once it reaches this stage, it is difficult to reverse, and liver function significantly declines. Symptoms such as swelling, jaundice, ascites, and easy bruising may appear.

④ Hepatocellular Carcinoma

If cirrhosis progresses further, the risk of liver cancer increases. While hepatitis B and C viruses are known to be major causes, it can also develop from alcoholic cirrhosis.

The important thing is that it progresses in stages from ① to ② to ③ to ④, and that there are almost no symptoms in the early stages. A health check-up result of "high γ-GTP" is an important sign to catch it in stage ① or ②.

Not just γ-GTP. Other values to look at.

To assess liver health, it's important to look at multiple values together, not just γ-GTP.

Test Item	What it reflects	Approximate Normal Range
γ-GTP	Alcohol burden, damage to biliary system	Men 50 or less, Women 30 or less (IU/L)
AST (GOT)	Damage to liver cells, heart muscle, muscles	30 or less (IU/L)
ALT (GPT)	Damage to liver cells (highly liver-specific)	30 or less (IU/L)
ALP	Damage to bile ducts, bones	Varies by institution
Total Bilirubin	Bile flow, indicator of jaundice	1.2 or less (mg/dL)
Albumin	Liver synthesis ability, nutritional status	4.0 or more (g/dL)
Platelet Count	May decrease as cirrhosis progresses	150,000 or more (/μL)

If γ-GTP is high but ALT is normal, it's likely primarily due to alcohol, and liver cell damage may still be minimal. Conversely, if AST and ALT are also high, it suggests that liver inflammation may be progressing. Since the condition is determined by the combination of values, it is dangerous to draw conclusions from a single item.

For those who say, "My γ-GTP is high even though I don't drink."

γ-GTP can also rise due to causes other than alcohol. If your levels are high and you don't know why, consider the following:

• Non-alcoholic fatty liver disease (NAFLD/NASH): Fatty liver caused by obesity, overeating, lack of exercise, diabetes, etc. Can occur even in non-drinkers.
• Gallstones/cholecystitis: Blockage in the bile ducts can raise γ-GTP.
• Medication effects: Some medications (e.g., anti-epileptic drugs, antibiotics, lipid-lowering drugs) can increase γ-GTP.
• Thyroid disease: Liver function values can fluctuate with hypothyroidism.
• Hepatitis B/C viruses: You may be infected without symptoms.

If you "hardly drink at all," we recommend getting a proper examination to investigate other potential causes.

How much is "too much" drinking?

The Ministry of Health, Labour and Welfare recommends a "sensible and moderate amount of alcohol" which is approximately 20g of pure alcohol per day. This translates to about the following, depending on the type of alcohol:

• Beer (500ml can): About 1 can
• Sake: About 1 go (180ml)
• Wine: About 2 glasses (200ml)
• Chuhai (7%, 350ml can): About 1 can
• Shochu (25%): About 100ml
• Whiskey: About 1 double (60ml)

If you drink "about 2-3 cans of beer every day," you've already exceeded this standard. Also, women tend to have a lower alcohol-processing ability than men, so the same amount of alcohol can cause greater liver damage. It's also considered important to "set aside at least two alcohol-free days a week."

What you can do starting today to lower γ-GTP

In cases of fatty liver or mild hepatitis, lifestyle changes often lead to improved numbers.

• Reduce alcohol intake / establish alcohol-free days (this is the most effective)
• Limit foods high in sugar and fat (be mindful of excessive fried foods, sweets, and white rice)
• Make moderate exercise a habit (even 30 minutes of walking can be effective in improving fatty liver)
• Lose weight if you are obese (a 5-10% weight loss can improve fatty liver)
• Get enough sleep (lack of sleep negatively affects liver function)

Many people understand this but find it difficult to cut back. Coming for a consultation doesn't necessarily mean you'll be told to stop drinking completely. If you can be honest about your current situation, we will work with you to find solutions that are manageable.

If you have these symptoms, please see a doctor early.

In addition to high γ-GTP levels, if you have any of the following symptoms, please see a doctor as soon as possible:

• You feel generally sluggish or tired persistently.
• You have a loss of appetite or nausea.
• You feel discomfort or heaviness in your right side (around your lower ribs).
• The whites of your eyes or your skin have turned yellowish (jaundice).
• Your urine has become dark brown.
• Your feet or face are swollen.

These symptoms may be a sign that some degree of liver damage has already progressed. Please do not ignore them thinking "it will get better eventually," but consult us early.

Liver Function Test Procedure at Our Clinic

1. Interview and Examination
   We will ask about your alcohol consumption, diet, medications you are taking, and medical history. If you have previous health check-up results, please bring them.
2. Blood Test
   We will check liver function related items such as γ-GTP, AST, ALT, ALP, bilirubin, albumin, and platelet count. If necessary, we will also perform tests for hepatitis B and C viruses. Results for appointments before 5 PM will be available as early as the next day.
3. Result Explanation and Treatment Plan Proposal
   We will explain the meaning of your numbers in an easy-to-understand way and propose appropriate actions, such as lifestyle changes, medication prescriptions, or referrals to specialist hospitals, depending on your condition.

Frequently Asked Questions

Q. My γ-GTP was high in my check-up, but everything else was normal. Should I go to the hospital immediately?
While it depends on the exact numbers, if it's above the normal range, we recommend coming in for a detailed examination. γ-GTP is sensitive to changes in alcohol intake, so it's especially important not to ignore it if you drink frequently.

Q. My numbers were higher than last month. Has anything changed?
This is often influenced by changes in alcohol consumption, diet, stress, or medications in the past 1-2 months. Please tell us anything you can think of.

Q. Will my numbers go back to normal if I stop drinking?
In the fatty liver stage, numbers often improve within several weeks to months with abstinence or reduced drinking. However, if it has progressed to cirrhosis, it's difficult to reverse, so early intervention is crucial.

Q. Can I get an ultrasound (echo) at your clinic?
We currently do not offer abdominal ultrasounds. If necessary, we will refer you to a cooperating medical institution.

For those concerned about liver function in Jujo, Akabane, Higashi-Jujo, or Oji

Surprisingly many people get flagged in a health check-up but put off seeing a doctor due to busyness. Liver diseases can sometimes be untreatable if symptoms appear too late, so it's important to act when you first notice concerning numbers.

Halu Clinic is open every day from 9 AM to 9 PM, including weekends and holidays. It's a convenient clinic to visit after work or on weekends. While walk-ins are welcome, we prioritize patients with web reservations.

Click here for WEB reservation　／　 Access & Clinic Hours　／　 Inquire via LINE

Halu Clinic｜1F J&MALL, 2-27-1 Kamijujo, Kita-ku, Tokyo 114-0034
TEL: 03-6698-2509 ／ Clinic Hours: Every day 9:00 AM - 9:00 PM (Irregular holidays)