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“You can get past the dead end. You can break through the ceiling. I did and so have countless others.”

Clinical Pearl Wednesday #172

Liver on yellow background

A CMP, a comprehensive metabolic profile, is a great source of information about your patient’s metabolic health, yet most of us only give it a glance.  Using the variety of levels included in the panel reveals a lot about your patient’s nutrition, liver, and kidney health, as well as electrolyte balance.  We’ve long known this.  However, we rarely use the information we see in these results.  

Using the AST, ALT, and alkaline phosphatase levels can be quite revealing.  Optimal AST and ALT levels run about 15-25 IU/L, while ideal alk phos is about 60 IU/L or so.  

We’ve long recognized that elevated liver enzymes indicate liver disease, but with Americans now developing metabolic syndrome in epidemic proportions, using these levels in a slightly different way can provider more insight into the overall health of our patients.  

If AST and/or ALT are lower than 15 IU/L, I’d consider the patient to likely be mildly to significantly malnourished, and if the AP is less than 50, I’d consider the same.  Most of the time, the nutritional deficits are low protein intake, poor iron/ferritin levels, and/or low vitamin D.  

Levels of these enzymes above these optimal ranges do indicate mild liver stress; maybe the stress is from medications they are taking, from fatty liver disease, or simply from developing metabolic syndrome and insulin resistance.  

Address each of these possibilities, and you’ll see symptoms and health improve! Patients will really thank you for going the extra mile, using optimal, not just normal lab ranges.  

For more on optimal lab reference ranges, see our course on nutrition.


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