Dear Doctor: I recently had blood work done, and now my doctor says my liver enzymes are too high. How can I lower them? I have no symptoms, so I was surprised. I have never consumed alcoholic beverages, nor smoked. I am trying to lose some weight. I do frequently take ibuprofen for arthritis.

Dear Reader: I am not certain which of your liver enzymes are elevated, but the ones most often tested are AST (aspartate aminotransferase) and ALT (alanine aminotransferase). These enzymes are important for enzymatic reactions in the liver, but they are also a marker for liver inflammation and injury. We'll start with those.

An obvious cause for liver enzyme elevation is alcohol, which directly damages the cells of the liver. In such circumstances, AST is more elevated than ALT. But, as you said, you don't drink. Other possible causes include chronic infection with hepatitis B or C, or a genetic disorder called hemochromatosis, which leads to iron deposits in the liver. Tests for hepatitis infection and for iron and ferritin (a protein containing iron) levels can help diagnose or rule out these conditions.

Many medications can inflame the liver, such as statins for lowering cholesterol. Stopping the statin is often necessary to see if the liver enzymes come back down to normal. As for ibuprofen, it and other nonsteroidal anti-inflammatory drugs, or NSAIDs, rarely cause liver inflammation, but acetaminophen (Tylenol) does, especially at high doses (more than 4,000 milligrams per day). But again, the only way to determine a connection is to stop the medication and see if the enzymes return to normal.

Heart failure can be linked to liver enzyme elevation, as can cancers of the liver and cancers that metastasize to the liver. These conditions can be diagnosed through imaging procedures such as ultrasound and CT. Autoimmune conditions are a possibility as well; these are better diagnosed with specific blood tests.

But after ruling out these conditions, the most likely cause of liver enzyme elevation is non-alcoholic fatty liver disease, the most common liver disorder in the United States. A 2017 study of 6,000 adult men and women estimated the prevalence of fatty liver in the United States around 30 percent. The rise of this disease correlates with the rise of obesity and diabetes.

To diagnose fatty liver, you must rule out other causes for liver disease, with the first being alcohol consumption. After that, an ultrasound of the liver is a sensitive and simple way to diagnose the condition. An MRI, although costlier, is also a good test to diagnose the disease. Rarely, a liver biopsy is necessary to diagnose and evaluate the extent of fatty liver.

The best treatment for this condition is weight loss. Studies have shown significant improvements due to weight loss among those with fatty liver. To decrease both blood sugar and the storage of fat, choose a diet that is low in sugars and simple carbohydrates.

Eliminating sweets, sodas and juices would be a good start. If you're overweight or obese, try for a gradual weight loss of 1 to 2 pounds per week. Although you don't drink alcohol, those who do -- and who have elevated liver enzymes or fatty liver -- should give it up.

With a good diet and exercise, your liver enzymes should start to decline. But make sure to monitor them to ensure that's the case.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: My husband and I have a running battle with two of our three kids, who have zero interest in anything that isn't on a screen. They're 11 and 13, so rational arguments about their adult health don't work. Just how important is it for kids to get regular exercise?

Dear Reader: We all want the best for our kids, which is often how those smartphones, tablets and video game consoles get into their hands in the first place. But as you rightly observe, children need a certain amount of physical activity in their lives for optimum health. Decades of research have (repeatedly) shown that adults who are physically fit have a decreased risk of developing chronic illnesses and conditions like heart disease, stroke, cardiovascular disease, certain cancers and diabetes. And as we've explored in recent columns, physical fitness also plays a role in improved mood and can help with depression.

Now, thanks to recent reviews of existing research, we're learning that those of us who were physically fit as children are more likely to be fit -- and healthy -- as adults. Yet at the same time, data shows that adolescents today are up to four times as likely to be overweight as they were in 1960. Fewer than half of children between the ages of 9 and 13 engage in organized physical activity outside of school. One-fourth don't take part in any free-time physical activity at all.

Add in the fact that these days, options for regular physical activity in many schools are quite limited, and it's more important than ever for parents to step up and help their kids get moving.

Which brings us to the excellent point you make regarding the challenge of motivating a child, particularly an adolescent, to exercise regularly. The same facts and statistics that are so compelling to us hold little meaning for someone whose next birthday, let alone the strange and distant land of adulthood, seems an eternity away. Meanwhile, the worlds that await within our screens are notoriously seductive. Getting kids engaged in the bland and boring real world isn't easy. But it's during adolescence that we establish what often turn out to be lifelong behaviors, and this includes physical activity. And it's during this crucial time that levels of physical activity tend to decline, a trend that is apt to be even more pronounced among girls.

Current exercise guidelines for children aim for a minimum of 60 minutes of activity per day, with aerobic exercise the gold standard for cardiovascular health. Walking, hiking, skateboarding, running, biking, dance, gymnastics and many team sports can get the heart pumping. Activities to strengthen muscles as well as controlled impact activities like jumping rope, hopscotch or running that help build bone are important.

One of the keys to getting kids off the couch is to model the desired behavior yourselves. Make physical activity a family priority. Family hikes with a picnic at the destination, a basketball hoop in the driveway, games of tag or catch, jumping rope and family bike rides are great ways to get everyone moving. The trick is to start small, build slowly and make it fun. And know that you're in it for the long haul.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: Did the surgeon general really just suggest that the general public carry naloxone in case they encounter someone having an opioid overdose? For starters, where would you even get such a thing? And two, how is the average person supposed to know who's overdosing -- and on opioids?

Dear Reader: The opioid epidemic is undoubtedly a national crisis. No other group of drugs has led to such a staggering number of overdose deaths in this country. Of the 63,632 overdose deaths in 2016, two-thirds were related to opioids, with synthetic opioids such as fentanyl and its illegal analogs proving especially dangerous. Overdose deaths from those drugs doubled in 2016 compared to 2015. Further, because these deaths are often concentrated in specific counties, the drugs have led to the destruction of families and even communities. They're widely available, and can be injected, inhaled or taken orally.

Opioids suppress the respiratory system by inhibiting the natural impulse for breathing. In short, with an overdose, people simply stop breathing. As for naloxone (Narcan), it's an opioid receptor antagonist, meaning that it blocks the action of the opioid. The drug typically is given intravenously in emergency situations by medical personnel, quickly reversing the respiratory depression. Even if the drug can't be given by vein, it can be administered by injection into a muscle or under the skin; it can even be placed within the nose via a spray. Although naloxone is a lifesaver, it must be quickly given to prevent death.

That fact prompted the surgeon general to state that naloxone should be carried by members of the general public in the event they encounter an opioid overdose. Already, naloxone -- in injectable or spray form -- can be obtained without a prescription in 46 states. (The other four require a doctor's order.) Because pharmacies carry the medication, one could simply obtain the medication from a pharmacist, who could then teach how to administer it.

As the surgeon general pointed out, naloxone would be beneficial for family members and friends of people struggling with addiction. The need is especially great in areas far from the medical personnel generally needed to provide the drug in a timely fashion.

As for when it should be administered, that would be when a friend or family member -- whom you know to be taking a prescribed or illegal opioid -- becomes non-responsive and stops breathing. First, you would perform CPR, complete with rescue breathing, and if you get no response after 30 seconds, you would give naloxone. The drug should work quickly, but if it doesn't, you would administer it again in two to three minutes.

One note of caution: The naloxone may precipitate a severe withdrawal from the drug, but opioids should not be given to combat this. Instead, further medical attention would be required.

But increasing the availability of naloxone won't eliminate all deaths from opioid overdoses. For starters, we could face a shortage of the medication and will likely need greater production of naloxone. And, of course, we need greater access to resources that can help us both treat and prevent opioid addiction.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)