Can Lyme Disease Cause High Liver Enzymes? What the Research Shows

If you have Lyme disease and bloodwork shows elevated liver enzymes, it’s reasonable to wonder: Can Lyme disease cause high liver enzymes?

The short answer is yes, it can happen—particularly during early Lyme disease.

In fact, one study of 115 people with early Lyme disease found that 40% had at least one abnormal liver test.

But there’s an important catch.

Elevated liver enzymes have many possible causes. If you have Lyme disease and your ALT or AST is elevated, you shouldn't automatically assume Lyme is responsible.

Let’s look at what the research actually shows.

What Are High Liver Enzymes?

When people talk about “high liver enzymes,” they’re usually referring to abnormalities found during routine bloodwork.

Two commonly discussed markers are:

• ALT (alanine aminotransferase)
• AST (aspartate aminotransferase)

Elevations can occur when cells containing these enzymes are injured or stressed. ALT is more closely associated with the liver, while AST is also found in tissues such as skeletal muscle.

That distinction matters because an elevated AST or ALT doesn't automatically tell you why it is elevated.

Possible causes can include liver disease, alcohol use, medications, supplements, infections, metabolic conditions, and even strenuous exercise.

The lab result is a clue. It isn't a diagnosis by itself.

Can Lyme Disease Cause Elevated Liver Enzymes?

Yes. Abnormal liver tests have been documented in people with early Lyme disease.

One frequently cited study published in Hepatology examined 115 patients with erythema migrans and early Lyme disease.

Researchers found that:

• 40% had at least one abnormal liver test.
• 27% had an elevated ALT.
• Liver-test abnormalities were more common among patients with early disseminated Lyme disease than those with localized disease.
• The abnormalities were generally mild.
• Most improved or resolved following antibiotic treatment.

This gives us an important distinction.

Lyme disease can be associated with abnormalities on liver testing, but this doesn't mean Lyme routinely causes severe liver disease.

The research primarily supports the possibility of mild liver-test abnormalities during early infection.

The Study

Horowitz HW, Dworkin B, Forseter G, et al. Liver Function in Early Lyme Disease. Hepatology. 1996;23(6):1412–1417.

https://pubmed.ncbi.nlm.nih.gov/8675158/

Why You Shouldn't Automatically Blame Lyme

This is arguably the most important point.

Someone diagnosed with Lyme disease may naturally begin attributing every abnormal symptom or laboratory result to Lyme.

But high liver enzymes are not specific to Lyme disease.

ALT and AST can become elevated for many reasons, including:

• Metabolic dysfunction-associated steatotic liver disease (fatty liver)
• Alcohol
• Viral hepatitis
• Certain prescription medications
• Over-the-counter medications
• Supplements and herbal products
• Other infections
• Muscle injury
• Strenuous exercise

That means seeing an elevated ALT on your bloodwork doesn't necessarily mean:

“Lyme is attacking my liver.”

The underlying cause still needs to be investigated.

Lyme Treatment and Liver Enzymes

There's another reason people being treated for Lyme disease should pay attention to liver testing.

Some patients take multiple medications, herbs, and supplements simultaneously.

Just because something is described as “natural” doesn't mean your body doesn't have to process it or that it cannot affect laboratory values.

This is one reason periodic bloodwork may be appropriate during certain treatment protocols, particularly when medications or supplements with potential liver effects are being used.

If liver enzymes begin increasing during treatment, your healthcare provider can look at the entire picture rather than automatically attributing the change to Lyme disease itself.

Could a Tick-Borne Coinfection Cause High Liver Enzymes?

Potentially.

A tick bite can expose someone to more than one pathogen, depending on the tick and geographic region.

One important example is Anaplasma phagocytophilum, the bacterium responsible for anaplasmosis.

The CDC lists common laboratory abnormalities associated with anaplasmosis including:

• Elevated aminotransferases
• Low white blood cell count (leukopenia)
• Low platelet count (thrombocytopenia)

Mild anemia can also occur.

CDC guidance has specifically noted that leukopenia or thrombocytopenia in a patient with Lyme disease should raise suspicion for possible Anaplasma coinfection.

That doesn't mean everyone with Lyme and elevated liver enzymes has anaplasmosis.

It means the overall clinical picture matters.

If someone has Lyme disease along with fever, abnormal blood counts, elevated liver enzymes, or other concerning findings, their healthcare provider may need to consider other tick-borne infections rather than assuming everything is being caused by Lyme.

CDC Resources

CDC — Clinical Signs and Symptoms of Anaplasmosis
https://www.cdc.gov/anaplasmosis/hcp/clinical-signs/index.html

CDC — Diagnosis and Management of Tickborne Rickettsial Diseases
https://www.cdc.gov/mmwr/volumes/65/rr/rr6502a1-2.htm

Can Exercise Raise AST and ALT?

This is another factor that's easy to overlook.

Strenuous exercise can sometimes increase AST and ALT, particularly when significant muscle damage occurs.

AST isn't found exclusively in the liver. It's also present in skeletal muscle.

So if you had unusually intense exercise shortly before bloodwork, your healthcare provider may consider that context alongside your other laboratory results.

Again, this illustrates why one abnormal number shouldn't be interpreted in isolation.

What Should You Do If Your Liver Enzymes Are High?

If your liver enzymes are elevated—particularly if they're significantly elevated, increasing, or remaining elevated—talk with your healthcare provider and investigate the cause.

Depending on your situation, that may mean reviewing:

• Prescription medications
• Over-the-counter medications
• Herbs and supplements
• Alcohol consumption
• Metabolic health
• Other infections
• Recent strenuous exercise
• Additional liver-test results
• Your symptoms and medical history

Don't stop prescribed medication based solely on an abnormal test without discussing it with the clinician managing your care.

And don't automatically put an abnormal result into the “Lyme bucket.”

Finding the actual cause matters.

Can Lyme Disease Damage the Liver?

Lyme disease has been associated with abnormal liver tests, especially during early infection, but clinically significant liver involvement appears to be uncommon.

The 1996 study discussed above found that abnormalities were generally mild and usually improved following treatment.

So there's a major difference between saying:

“Lyme disease can be associated with elevated liver tests.”

and:

“Lyme disease is damaging my liver.”

The first statement is supported by published evidence.

The second requires considerably more investigation.

The Bottom Line

Can Lyme disease cause high liver enzymes? Yes.

Mild liver-test abnormalities have been documented during early Lyme disease. In one study of 115 patients, 40% had at least one abnormal liver test and 27% had elevated ALT.

But elevated liver enzymes are not specific to Lyme disease.

Medications, supplements, alcohol, metabolic liver disease, viral infections, strenuous exercise, and other tick-borne infections can potentially contribute.

If your liver enzymes are elevated, don't automatically assume Lyme is responsible.

Treat the abnormal lab result as a clue and work with your healthcare provider to figure out why it's happening.

Frequently Asked Questions

Can Lyme disease cause high liver enzymes?

Yes. Mild abnormalities in liver tests have been documented in early Lyme disease. One study of 115 patients found that 40% had at least one abnormal liver test, while ALT was elevated in 27%. However, elevated liver enzymes have many possible causes and should not automatically be attributed to Lyme disease.

Which liver enzymes can be elevated with Lyme disease?

ALT and AST may be elevated in some people with early Lyme disease. The published research suggests these abnormalities are generally mild rather than evidence that Lyme routinely causes severe liver disease.

Can Lyme disease cause elevated ALT?

Yes. In a study of 115 people with early Lyme disease, ALT was elevated in approximately 27% of patients. Most liver-test abnormalities improved or resolved following antibiotic treatment.

Can tick-borne coinfections cause elevated liver enzymes?

Yes. Anaplasmosis is one example. The CDC lists elevated aminotransferases among common laboratory abnormalities associated with anaplasmosis, along with low white blood cell and platelet counts.

Should I be concerned about high liver enzymes if I have Lyme disease?

Elevated liver enzymes should be evaluated rather than automatically attributed to Lyme. Medications, supplements, alcohol, metabolic liver disease, other infections, strenuous exercise, and other conditions can also affect ALT and AST. Talk with your healthcare provider if your levels are elevated, particularly if they are significantly elevated or remain abnormal.

Want Help Looking at the Bigger Picture?

Lyme recovery can become incredibly focused on one question:

“What kills Lyme?”

But recovery often requires looking at a much bigger picture—your symptoms, lifestyle, treatment strategy, sleep, nutrition, medications, supplements, and the other factors that may be affecting how you feel.

That's exactly what we'll be discussing during my free 4-Day Lyme Recovery Experience starting September 21st.

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This article is for educational purposes only and is not intended to diagnose, treat, cure, or prevent any disease. Elevated liver enzymes can have many causes and should be discussed with a qualified healthcare professional.