Hi {{first_name|there}},
Last week we went through ALT and AST. This week, the bigger question: why those two are often the only liver-related numbers on a standard panel, and what sits outside it.
What the standard panel is for
The metabolic panel from an annual physical is built to catch things that are already a problem: kidney function, electrolytes, blood sugar today, liver enzymes high enough to matter. It's a good screen for that. It isn't built to show direction, or to show the markers that move years before the enzymes do.
What usually isn't on it
Fasting insulin, which rises long before fasting glucose does. GGT, a liver enzyme that tracks oxidative stress and alcohol load. Homocysteine, which the liver's methylation pathway controls. hs-CRP, a general inflammation marker. ApoB, a more specific read on cholesterol particles than LDL alone. A full thyroid panel rather than TSH by itself. Ferritin and vitamin D.
None of these are exotic. They're just not on the default order, and most people have never had them run as a set.
How people get them
Three ways. Ask your provider to add them to the next draw, which works when there's a reason to. Order them through a direct-to-consumer lab service, which is what more of the clinic's patients do for a once-a-year baseline. Or book a visit with us and we'll order what fits your situation.
Whichever way the results come back, the numbers mean more read next to each other than one at a time. Severe pain, a fever, or yellowing of your skin or eyes needs medical care right away, whatever's on a panel.
Questions worth bringing to your next visit
Which of these has never been run on me?
Is a fasting insulin on my next draw?
If I get a larger panel done somewhere else, will you read it with me?
Nurse Doza
This email is for education. It isn't a diagnosis or a treatment plan. If something here sounds like you, bring it to your next visit and we'll look at it together.
P.S. On Tuesday we'll tell you about the lab service Nurse Doza points patients to for the full baseline: 100+ biomarkers, one draw, $349 a year.
Already have results from anywhere? The $99 lab review reads them line by line.
Had your gallbladder removed?
Your liver still makes bile. It just reaches your gut differently now. Class four of Nurse Doza's Gallbladder Health course covers how to support your digestion after removal. Five classes, $10, and through Oct 31 the Digestion course comes free with it.