This week’s focus on blood chemistry analysis is digestion and liver function. Both of these are related to each other. The digestive system involves liver function. The liver, whose function includes digestive activities, is a massive organ that has multiple roles in the body’s biological processes. Click HERE to review the major functions of your liver. The liver produces bile, detoxifies the blood, synthesizes cholesterol, is necessary to make hormones, controls the release of glycogen to regulate glucose metabolism and performs hundreds of other functions.
Liver Activity On A Blood Test
The following chemistry factors on a basic blood test can be used to assess liver function. I have included the reference ranges that I use for each.
- GGTP 10-30
- AST 10-30
- ALT 10-30
- ALP, Alkaline Phosphatase 60-100
- LDH 150-200
- Total Bilirubin 0.2-1.2
- Albumin 4.1-5.1
- Triglycerides 60-100
The first 5 blood chemistry factors (GGT, AST, ALT, ALP, LDH) are metabolic enzymes that are found in high concentrations in the liver and other parts of the body as well.
GGTP (gamma glutamyl transferase)
GGT (gamma glutamyl transferase) is a metabolic enzyme found chiefly in liver cells and therefore is a sensitive factor for assessing liver damage. It is very common that GGT levels will be elevated with regular alcohol consumption. Since pharmaceutical drugs also tend to have a toxic effect on the liver, it is common to see elevated GGT levels with those on prescription medications. GGT levels greater than 30 strongly correlate with hepatic-related issues.
High levels of GGTP indicate possible destruction to liver cells, as well as potential bile tract blockage. The latter is true especially is correlative with elevated levels of ALP.
AST (aspartate aminotransferase)
AST is less of a sensitive metabolic enzyme for the assessment of liver issues. It is more often found elevated (>35) among those with cardiovascular risk factors. Nonetheless, elevated AST may indicate damage to the liver if correlated with other blood chemistry factors such as ALT, ALP, GGT and LDH.
ALT (alanine aminotransferase)
ALT is another metabolic enzyme that is found in liver, muscle, heart and kidney cells. High levels of this enzyme will be released into the bloodstream when there is damage to these specific cells. ALT levels of 35 or greater tend to indicate various stages of liver dysfunction and liver breakdown. ALT results should be correlated with other blood chemistry factors.
ALP (alkaline phosphatase)
Typically ALP levels greater than 100 can be found correlative with varying degrees of liver dysfunction. ALP is a metabolic enzyme found in bone, intestines and liver. Therefore, abnormal values may correlate with numerous dysfunction. If ALP is found to be greater than 100 in adults, suspect that liver issues exist, especially if correlated with high levels of GGT and ALT. Low levels of ALP correlate with a zinc deficiency. If ALP is low, consider also Hypochlorhydria (low stomach acid).
LDH (lactate dehydrogenase)
LDH is a group of metabolic enzymes that reflect carbohydrate metabolic activity. LDH is found in virtually all tissues of the body. So elevated LDH levels have limited value. LDH is often elevated >200 when there is congestion in the liver. If this is the case, one may see elevated bilirubin, ALP (alkaline phosphatase), ALT, GGT and AST may also be elevated as well in liver congestion and/or dysfunction.
Bilirubin is a waste product. It is the result of the breakdown of hemoglobin. Bilirubin is transported by spleen and bone marrow cells to the liver where it is then conjugated and excreted through bile. If ‘Total Bilirubin’ is elevated greater than 1.2, expect some sort of liver dysfunction or possible biliary tract obstruction. This should be correlated with other blood chemistry values.
Albumin is a major blood protein. Albumin regulates fluid balance as well as facilitating the transport of hormones. It is produced mostly in the liver. When liver dysfunction or congestion of the liver is present, blood albumin will tend to be decreased.By itself, a decreased albumin level is indicative of digestive inefficiencies, including stomach alkalinity.
Triglycerides are fats in your blood which serve as a source of fuel for all of the muscles of the body. High or low triglycerides are indicative of numerous metabolic problems as well as potential risk factors. Triglyceride values on a fasting blood test are synthesized by the liver. Consider that a triglyceride level greater than 110 may reflect fatty liver and/or liver congestion. This should be correlated with other values.
Elevated triglyceride levels may be less reflective of excess consumption of dietary fats, and more reflective of excess carbohydrate consumption and/or a breakdown in the liver’s ability to emulsify fats.Low levels of triglycerides can indicate toxicity,
Digestive Function In Blood Chemistry
I use the following functions on a blood test to assess various aspects of digestive function. I have provided the reference ranges that I use for each chemistry factor.
- BUN 14-20
- Albumin 4.1-5.1
- Globulin 2.4-2.8
- Chloride 100-106
- MCV 80-90
- MCH 28-32
- Anion Gap (sodium + potassium) – (Co2 + Chloride), 7-12
Digestive Dysfunction #1: Hypochlorhydria
Inadequate production of stomach acid is a major clinical and sub-clinical stress on the body.
Hydrogen is vitally important for your stomach’s production of HCL (hydrochloric acid). The higher the ph of the stomach, the weaker digestive functions will become.
Hydrochloric acid (HCL) is the primary gastric acid secreted by your stomach. Its role in digestion and the regulation of ph in the body is critical for maintaining your health in a number of ways.
Hypochlorhydria, otherwise known as low hydrochloric acid (HCL) is a very common problem that can be both a cause of and a result of numerous health issues, including poor digestion and assimilation of amino acids and minerals.
The primary role of hydrochloric acid is to sterilize the food you eat and to prevent harmful bacteria from entering the GI tract. HCL also triggers the release of enzymes such as pepsin which are essential for the digestion of protein.
Upon being released by the parietal cells of the stomach, HCL also triggers the release of alkaline bicarbonate into the blood. Its important to mention that HCL production is a major expenditure of biological energy. There are numerous minerals that are hydrochloric acid dependent, chiefly:
Of these minerals, zinc and sodium are both are responsible for the production of HCL.
This means that deficiencies in HCL can and likely will result in the inability to utilize several vitally important minerals and nutrients! Think of the possible nutritional deficiencies, various forms of anemia, and heath issues that can result from reduced or low HCL production!
While not 100% definitive, on a blood test, hypochlorhydria can be identified through a number of correlative indicators. The 2 most definitive are:
- Chloride < 100
- Co2 > 27
- Anion Gap > 12
Additionally, it may be common for someone with hypochlorhydria to have the following chemistry factor values:
- BUN >16
- Phosphorous < 3.0
- MCV > 90
- Globulin >2.8 or <2.4
- Albumin <4.1
- Potassium 4.5 or > and sodium 135 or <
Subjective indicators that correlate with a possible HCL insufficiency: Bloating after meals, foul smelling gas, undigested food in stools, constipation, acid indigestion, GERD
Digestive Dysfunction #2: Pancreatic Insufficiency
The pancreas produces enzymes and secretes them into the duodenum for protein, fat and carbohydrate digestion. The pancreas is signalled to secrete enzymes by the hormone CCK (cholecystokinin). The necessary amount of pancreatic enzymes depends upon the action of digestive processes in the stomach, including pre-digestion and HCL production. Inadequate HCL and stomach enzymes can cause a pancreatic enzyme insufficiency.
The pancreas and stomach are both heavily involved in protein digestion and assimilation. Poor breakdown of protein leads to dysbiosis and putrefaction, as well as increased renal stress. On a blood test, the following chemistry factors are indicators of pancreatic insufficiency:
- BUN <14
- GGTP >30
Subjective indicators a person may have a pancreatic insufficiency are gas and bloating after a meal. It may be hard to distinguish between subjective indicators of hypochlorhydria and insufficient pancreatic enzymes. It is common for both to be present.
Digestive Dysfunction #3: Bile Insufficiency
Bile is produced by the hepatocyte cells of the liver from cholesterol. When acidified food enters into the small intestine from the stomach, bile salts alkalinize the food, preparing nutrients for assimilation in the small intestine.
Bile emulsifies fat, increasing fat absorption. Bile also contains the conjugated toxins from the 2 phases of liver detoxification. These toxins may include carcinogens, xenobiotic chemicals, pharmaceuticals and heavy metals like mercury, aluminum and lead. When hemoglobin is broken down in the liver, bilirubin is conjugated and excreted through the bile.
The following chemistry factors indicate a possible bile acid insufficiency:
- Total Bilirubin >1.0
- GGTP > 30
Heartburn and GERD symptoms can actually be a sign of bile acid insufficiency. If there are symptoms of upper abdominal tightness this may also be indicative of bile insufficiency.
This concludes part 3 of “Secrets of Blood Chemistry Analysis”. Stay tuned next week for part 4.