Liver enzyme question.

[Badger12345]

I know there are lots of posts about the alt/ast ratio. I have spent more time than I care to admit reading about that damn ratio! I just wondered if anyone had any experience or educated opinions on an inverted ratio alongside low alk phos levels? I recently had bloodwork done and my AST was 21, ALT was 18 and my Alk phos was 33. Are these numbers indicative of anything? I do have a follow up appt scheduled with my doctor, but since he is a general practitioner I do not expect him to be particularly well versed on the ratio or even just interpreting these numbers in a meaningful manner.

I also had high ldl cholesterol (yet I am an extremely healthy eater, exercise regularly and at the low end of my healthy weight range. So my cholesterol was a little surprising.) I was drinking heavily up until January when I completely quit.

Thank you so much in advance for any input.

[Kakey]

Those are normal results, if I use my lab 's values.

[Badger12345 in reply to Kakey]

My alk phos is outside (below) the accepted range used by my lab.

[MINTVCX]

Well ast/alt ratio (used for example in BARD score) is pretty good to exclude advanced fibrosis (F3-F4). But not so good to confirm it (low PPV). In other words when you have ast/alt > 1 it can be some indicator to do more specific tests but in 45%-50% cases is false positive.

Remarks

1. We talk about probability of having F3-F4. It is not good validated to predict F1, F2 fibrosis.

2. It alone does not show your liver status. It is some probability.

mdcalc.com/bard-score-nafld...

[nerd1]

Hi Badger, I'm not a doctor etc. but some things associated with a low alk phos level are: hypothyroidism, pernicious anemia, zinc deficiency and Wilson's disease (source: YouTube 'Interpretation of LFTs' by Strong Medicine, around the 12.30 mark).

[MINTVCX]

One more question. Is your bilirubin level in normal range? Everyone is in different situation of course but I have similar situation about high Ldl without obvious reason.

[Badger12345 in reply to MINTVCX]

Bilirubin was 0.4 out of a range of 0.0-1.2.

My LDL was 131. Dr said if I go higher by next appt in 6 months they might consider medication. He believes it’s possibly a genetic issue.

I do have a concern that everything is connected though, and was wondering if high ldl, low alkaline phos, and inverted ratio (when combined) might point to something. Thank you so much for your feedback.

[MINTVCX in reply to Badger12345]

I see. I have 142 ldl. It is not so big value I think if HDL is high and triglycerides low. Have you got ultrasound?