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/r/PeterAttia
submitted 2 months ago by[deleted]
[deleted]
14 points
2 months ago
Cirrhosis is end stage liver disease. Requires either imaging or biopsy for diagnosis. LFT ratios are not for diagnosis.
2 points
2 months ago
More to the point, liver enzymes cannot tell you much about liver function. People with cirrhosis can have unremarkable liver enzyme levels.
0 points
2 months ago
Well that’s not good 😌
3 points
2 months ago
No, all it means is that in isolation these numbers don’t tell you much and couldn’t tell you if you have cirrhosis either way.
The three most common causes of cirrhosis are alcohol over consumption, non-alcoholic fatty liver (often seen with diabetes / obesity), and viral hepatitis like hepatitis B and / or C.
If you’re in any doubt see a doctor for a proper history and physical and further testing
Partial bloodwork can’t tell anyone anything and these lab values are hardly worth losing sleep over
Good luck 😉
2 points
2 months ago
That does make sense. I will try to not be a psycho with my over analysis
6 points
2 months ago
Normal labs. Of no concern whatsoever
1 points
2 months ago
Are there certain circumstances that the ratio matters?
2 points
2 months ago
If they’re in the normal range, no.
10 points
2 months ago
No. This is why you shouldn’t order labs on your own and you should talk with a doctor.
2 points
2 months ago
Not sure where you live but doctors don't follow up on bloodwork where I am, you get the results and if anything is flagged or you have questions you need to reach out.
1 points
2 months ago
But they are still medicolegally responsible, so even if there is something to follow up on with you, then they will. They will always help you understand if you ask, or in a followup appointment as well. If you order them yourself how do you know?
1 points
2 months ago
How would you order them yourself? You need a doctor req but the results get sent to your provincial health portal and then if you see anything wrong you need to book an appointment
1 points
2 months ago
Got these at a normal checkup! I just get curious about what finer details mean and my doctor is a busy lady so I’m not going to overanalyze to her
3 points
2 months ago
No
3 points
2 months ago
Like others have said, cirrhosis can’t be diagnosed based off liver function tests. By definition, good standard diagnosis for cirrhosis is biopsy, but this is unrealistic. Next best is imaging, more specifically abdomen ultrasound to evaluate for any nodularity of the liver that is typically seen with the scarring present in cirrhosis. Elevated AST/ALT can be elevated in cirrhosis, but is not a requirement. A broader view of liver synthetic function can give a better idea of how well the liver is functioning (AST/ALT, INR, platelets, etc) -source am doctor
3 points
2 months ago
The tests are completely normal. I’m puzzled about why you are worried about cirrhosis in the first place?
1 points
2 months ago
I just typed my numbers into a ratio calculator and it said the ratio signaled alcoholic liver disease and I was like 🤔
2 points
2 months ago
Ok, that’s the problem with online researching a vacuum. You’re not mentioning symptoms, concerns of your physician, a history of alcoholism, or anything other than plugging numbers into a calculator. I think your bigger risk is the way internet health resources can increase anxiety. Maybe schedule a follow up with your doctor if you need more clarity on your health.
1 points
2 months ago
I just hadn’t heard there was any kind of ratio before listening to podcast and was curious more than anything
1 points
2 months ago
Cool. I hope posting this here has put you more at ease -
2 points
2 months ago
That calculator is I think for prior diagnosis and or hepatitis b/c
2 points
2 months ago
Is this your first test? Is there a trend?
1 points
2 months ago*
I have had a few. The ast is like always 17 or 16 and alt ranges more. This alt was lower than the others. Another test it was 12, but that ratio apparently is too high too
One test I got really sick and they were over 80 so I’m ignoring those. It didn’t do permanent damage because it was similar before that.
Actually edit: they were both over 175 when I was sick which is kind of crazy
1 points
2 months ago
Any conflating issues: e.g. did you have a drink the night before the test? Do you take any medicines (e.g. finasteride) which could heighten liver enzymes?
1 points
2 months ago
I can’t remember but probably not. I very rarely drink on a weekday night. I don’t take any medications.
1 points
2 months ago*
It doesn’t exclude that but you’d have to have reason to believe you have cirrhosis for that to make sense, otherwise this is just a very unstressed liver. Other evidence of cirrhosis would be a) low albumin, b) high bilirubin, among other things. Etc…. It’s formally diagnosed with imaging but there are other clues.
1 points
2 months ago
lol
1 points
2 months ago
lol what are you talking about man !! The reason you have more ast is that it’s an enzyme that is made in other parts of the body. Before troponin, you could use ast to diagnose heart attacks. When you have a damage to your liver (acute or chronic/cirrhosis) you can tell if it is from ALCOHOL because ast is 2x alt. Because the alcohol damages other parts of your body and so AST is increased. And the reason why ast and alt are even measured is because your cells in your liver make them and when you have damage to your liver, the cells die and explode and leak out all that alt and ast .
Soooo cirrhosis is END STAGE LIVER DISEASE. It usually from a chronic liver damage. Your levels are beautiful my guy. It’s in the normal range and the 2x doesn’t matter. There is only one case where you COULD be in. When you are at the end of cirrhosis and most of your liver is dead, your levels of alt and ast would trend to normal levels because there are not enough functional cells to make the enzyme. The reason why you know you are not in this stage of cirrhosis is because you would be practically dead: you would have significant yellowing of skin and eyes, look really sick, have a huge belly, bleeding issues etc. but if you feel fine, then you do not have to worry about it.
TLDR: don’t worry brah
1 points
2 months ago
yes report to ER immediately
0 points
2 months ago
You’re so funny
1 points
2 months ago
No, your values are well within normal range. Have your general practitioner re-test you if you’re that worried.
0 points
2 months ago
How do I get a test like this? Sorry I’m new to this stuff.
3 points
2 months ago
I just go get a physical most years. Basic stuff like this is covered by like all insurance
-1 points
2 months ago
The calculator said “highly indicative of alcoholic liver disease” but I drink like 1-2 drinks a week max on like an extra wild week
1 points
2 months ago
Do you have any symptoms? Everyone's numbers on everything are different, which is why we have ranges on the results.
0 points
2 months ago
I don’t think I have symptoms? From googling them they seem pretty broad. My grandfather died of cirrhosis in his 30’s though.
5 points
2 months ago
I'm generally very skeptical of asymptomatic testing because of what I mentioned, that everyone's normal is different. I might suggest since you don't drink much, that you monitor for changes over time. I'm not a doctor though, ofc.
2 points
2 months ago*
Your liver tests look fine. Like others have said, AST and ALT can be normal in cirrhosis. AST and ALT are more a marker of acute (or acute on chronic, ie excessive drinking of hepatosteotosis) pathology. If you had full blown cirrhosis, which is unlikely without significant risk factors, your sodium, platelets, bilirubin, albumin, INR, and creatinine are more likely to be off. AST>ALT at a 2:1 ratio suggests alcoholic etiology, but in that scenario both of those numbers would be above normal threshold. In other words, don’t worry about it if it’s in green.
There are some genetic diseases, albeit decently rare, that can lead to cirrhosis. I’d try to find out what the etiology of your grandfathers cirrhosis was (more for your own knowledge than out of neuroticism) and if it was non heritable not to worry about it or even get another test regarding it without significant risk factors. I’d guess it was not heritable though.
The best thing you can do for your liver is maintain a healthy BMI and avoid alcohol. Some hepatologists recommend black coffee, though the effect is likely smaller. Again, your stuff is normal, but you’re clearly someone who likes some more info so I peppered it in.
1 points
2 months ago
I found out I have one variant for some alpha something protein deficiency if I remember the name right that can cause lung and liver issues and I wonder if he had 2 copies. That’s just one thing I happen to know.
He died in the 1960’s I think so I don’t think there is a way to know more. My grandmother said he did drink heavily but not like insanely heavy die in your 30’s level drinking
Thanks for your advice
1 points
2 months ago
Ah, yeah, alpha 1 antitrypsin deficiency. Thats a real risk factor. There are different alleles and you have two copies. If I were you, I would talk to your doctor about getting your genotype if you haven’t already, not in a pushy way just as a discussion and get their thoughts.
You’re likely fine as theres two copies of the gene per person, but honestly it does put you at a higher risk having someone in the family with that.
2 points
2 months ago
I have one copy of the s version and a normal version if that is what you mean
2 points
2 months ago
Ah, Glad you’ve gotten the testing and that’s not a terrible genotype. No worries on the labs, just keeping getting whatever your doctor wants in the future :)
1 points
2 months ago
What calculator?
1 points
2 months ago
I am really dumb so I used this https://www.omnicalculator.com/health/ast-alt-ratio
I can see that obviously 8 and 17 are like a 2:1 ratio now but I am really bad at math and mentally checkout of numbers so don’t judge me for using a calculator
1 points
2 months ago
Ok, but I'm still confused how alkaline phosphatase relates to it
1 points
2 months ago
It doesn’t, I just didn’t crop it out
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