LifeCare Chiropractic

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ALT

THE NUMBERS OF PREDIABETIC PATIENTS JUST SHOT UP!!

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THE NUMBERS OF PREDIABETIC PATIENTS JUST SHOT UP!!  If you’re a regular reader of my updates, you know that a large chunk of the population is prediabetic.  Probably well over 50%.  That number is about to get much larger based on this study.  It is well established that being prediabetic is bad for the liver and induces a condition called non-alcoholic steatohepatitis (NASH).  That mild elevation in liver enzymes that your doctor can’t find a reason for and just says it must be genetic?  Yup.  Prediabetes.  But it gets worse.  This study finds that our normal range (usually 2-60) is not even close to good enough.  In men, >22 and women > 10 is a strong predictor of developing diabetes in the next few yrs.  Wow!!  These are some pretty harsh numbers!!  So, next time your doctor calls and tells you your labs are “normal,” make sure you get a copy of them yourself so you can double check the numbers.

 

NORMAL LIVER ENZYMES LINKED TO DIABETES?

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NORMAL LIVER ENZYMES LINKED TO DIABETES?  I remember early on in practice not recognizing this for what it was.  I had a few patients with mildly elevated liver enzymes (AST, ALT).  They would just comment that they’ve always been elevated.  Usually their doctor had run a barrage of liver tests looking for viral hepatitis.  But, with time, I’ve come to understand that prediabetes is very damaging to the liver, just like every other organ that is affected by this condition. I’ve even come to recognize that high normal values, when combined with other factors (abdominal obesity, elevated cholesterol / triglyerides, elevated uric acid, etc..) are a strong sign of prediabetes.  Something else to consider here…we view AST and ALT as “liver function” tests.  What we’re really looking at here are cells that are dying off and spilling their enzymes into the blood stream.  Doesn’t really sound like a test of “function” but rather a test of “dead…”

 

DO YOU KNOW YOUR ALK PHOS LEVELS?

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First, let’s talk liver “function” testing.  Or any other type of “functional” testing done in mainstream medicine, for that matter.  There are enzymes produced in cells.  We can check the levels of these enzymes in the blood and a certain level of them is expected.  This includes enzymes like AST, ALT and alkaline phosphatase (ALP).  AST and ALT are generally associated with the liver while AP is associated with the bone, although the enzymes is also present in the liver.

When cells of the body begin to die (such as the liver, heart, brain, muscle or bone) they spill out their enzymes into the bloodstream, causing the levels of these enzymes to rise.  So we’re looking for dying cells.  Does NOT really sound like a “function” test to me–sounds like a “cells are dying because the organ is really, really sick” test to me.  In other words–it is NOT a good thing.

This particular study, like others before it, is beginning to suggest that just because a lab value is “normal” does not mean it’s good.  With enzymes in the bloodstream, it’s becoming accepted that lower is better.  In this particular case, those with higher levels of ALP had up to an 84% increased risk of dying–generally the outcome we all want to avoid as much as possible.

Couple this with multiple studies finding elevated normal levels of ALT being very strongly associated with the risk of diabetes, meaning that any elevation means you are prediabetic.  Remember–this is within the normal range!!

http://www.sciencedirect.com/science/article/pii/S0002934311001847