ATP Project episode #110 “You and your blood”

Topics covered in podcast:

  • LFT (liver function test)
    • Not liver function; it is a test looking for liver damage or liver blockage.
    • alcohol
    • supplementation and medication
    • muscle damage and exercise
  • RFT (renal / kidney function test)
    • muscle damage and exercise
    • CK
    • filtration rate
    • uric acid
  • FBC (Full blood count or Red blood cell count)
    • anion gap plus bicarb = acid / base balance
    • cell size
    • Folate – MCV, Hb, neutrophils, platelets, homocysteine, MTHFR
  • iron studies
    • deficiency / in transit / lacking cofactors
    • scurvy / vitamin C deficiency
  • WCC
    • types of cells
    • infection / allergy / parasite / intolerance
    • autoimmune or deficiency
  • allergy / intolerance
    • IgA, IgE, IgG, IgM
  • inflammation
    • esr
    • crp
  • lipid profile
    • triglycerides
    • cholesterol
  • Hormone testing – male and female
    • HPA (adrenal axis)
    • HPG (gonadal axis)
    • HPT (thyroid axis)

Reference guide available on atpscience.com

LFT (liver function tests)

LFT does not measure liver function. It looks for liver damage and liver blockage. Any defect in function is not detected until it proceeds to damage or blockage.

BUT these markers are not exclusive to the liver,they are the same compounds released from other damaged, struggling or healing cells in your body. Blood tests are designed to serve the population based on averages and assumptions. Those that exercise and live a life of lifting and pushing their bodies can not fit with the norm and confuse the medical model. Refer to table 1 to see other locations for the markers listed under “LFT”.

The magnitude of aminotransferase alteration can be classified as “mild” (< 5 times the upper reference limit), “moderate” (5–10 times the upper reference limit) or “marked” (> 10 times the upper reference limit).

 

table from Edoardo G. Giannini, Roberto Testa, and Vincenzo Savarino. Liver enzyme alteration: a guide for clinicians. CMAJ. 2005 Feb 1; 172(3): 367–379. doi:  10.1503/cmaj.1040752 PMCID: PMC545762

 

The following paper shows how training can increase markers of tissue damage that can be diagnosed as liver damage. In this trial they demonstrated that training can increase liver enzymes for up to 96 hours after seated calf raises. Kanda K, et al. Evaluation of serum leaking enzymes and investigation into new biomarkers for exercise-induced muscle damage. Exerc Immunol Rev. 2014;20:39-54

AST and ALT

AST and ALT are enzymes which are important contributors to the citric acid cycle.

High AST:ALT associated with P5P deficiency

Both enzymes require pyridoxal-5′-phosphate (vitamin B6) in order to carry out this reaction, although the effect of pyridoxal-5′-phosphate deficiency is greater on ALT activity than on that of AST. This has clinical relevance in those with vitamin B6 deficiency as it may decrease ALT serum activity and contribute to an increase in the AST/ALT ratio.

High AST/ALT can be from B6 deficiency. B6 deficiency reduces ALT.

ALP

ALP is an enzyme that transports metabolites across cell membranes. Liver and bone diseases are the most common causes of pathological elevation of ALP levels, although ALP may originate from other tissue, such as the placenta, kidneys or intestines, or from leukocytes. Hepatic ALP is present on the surface of bile duct epithelia. Liver and Gall bladder blockages enhances the synthesis and release of ALP, and accumulating bile salts increase its release from the cell surface.

GGT (γ-Glutamyl transpeptidase)

GGT is an enzyme that is present in hepatocytes and biliary epithelial cells, renal tubules, and the pancreas and intestine. GGT can be induced by several drugs, such as anticonvulsants and oral contraceptives. Elevated GGT levels can be observed in a variety of non-liver diseases, including chronic obstructive pulmonary disease and renal failure, and may be present for weeks after a heart attack. Increased serum levels observed in alcoholic liver disease can be the result of enzyme induction and decreased clearance.

LDH

Lactate dehydrogenase (LDH) is a protein that helps produce energy in the body.

Medicines that can increase LDH measurements include numbing medicines (anesthetics), aspirin, clofibrate, fluorides, mithramycin, opioids, and procainamide.

A higher-than-normal level may indicate:

  • Blood flow deficiency (ischemia)
  • Heart attack
  • Hemolytic anemia
  • Infectious mononucleosis
  • Leukemia or lymphoma
  • Liver disease (for example, hepatitis)
  • Low blood pressure
  • Muscle injury
  • Muscle weakness and loss of muscle tissue (muscular dystrophy)
  • New abnormal tissue formation (usually cancer)
  • Pancreatitis
  • Stroke
  • Tissue death

 

Bilirubin

Bilirubin is the product of hemoglobin catabolism within the reticuloendothelial system. Heme breakdown determines the formation of unconjugated bilirubin, which is then transported to the liver. In the liver, UDP-glucuronyltransferase conjugates the water-insoluble unconjugated bilirubin to glucuronic acid, and conjugated bilirubin is then excreted into the bile.

 

 

Albumin

Albumin is a protein made by the liver. Albumin serves in the transport of bilirubin, hormones, metals, vitamins, and drugs. It has an important role in fat metabolism by binding fatty acids and keeping them in a soluble form in the plasma. This is one reason why hyperlipemia occurs in clinical situations of hypoalbuminemia. The binding of hormones by albumin regulates the amount of free hormone available at any time. Because of its negative charge, albumin is also able to furnish some of the anions needed to balance the cations of the plasma.

increased by

  • Anabolic steroids,
  • Androgens
  • Growth hormone
  • Insulin
  • Dehydration
  • High protein diet
  • Having a tourniquet on for a long time when giving a blood sample

low levels

  • Kidney diseases
  • Liver disease (for example, hepatitis, or cirrhosis that may cause ascites)
  • nutrient deficiency, protein deficiency and fasting
  • After weight-loss surgery
  • Crohn disease
  • Low-protein diets
  • Celiac disease
  • Whipple disease

 

Globulin

The globulin fraction includes hundreds of serum proteins including carrier proteins, enzymes, complement, and immunoglobulins (75% are IgG) . Most of these are synthesized in the liver, although the immunoglobulins are synthesized by plasma cells.

increased by

  • increased immunoglobulins / antibodies
  • illness

decreased by

  • Malnutrition
  • congenital immune deficiency
  • nephrotic syndrome

 

Fatty Liver is not the liver’s fault

NASH / NAFLD is diagnosed by liver function tests but is not actually a liver disease. It is an insulin issue / metabolic syndrome. The changes to liver enzymes and LFT occurs once there is substantial damage. Insulin resistance testing and ultrasound would have shown the predisposition and allowed for prevention. This is predicted to be leading cause of liver transplant by 2020 and at this point in time is being managed only after liver damagae has occured.

anion gap

= difference between unmeasured anions and unmeasured cations

[anionic proteins + inorganic phosphate + sulfate + organic anions] minus [potassium + calcium + magnesium + cationic proteins]

High anion gap = acidosis – lactic acid, Diabetic ketoacidosis and supplemental ketones (beta hydroxybutyrate BHB), salicylate accumulation, metabolic acidosis, respiratory acidodis, Uremia, Propylene glycol, Isoniazid intoxication, Rhabdomyolysis/renal failure, metabolic alkalosis, hyperphosphatemia

normal = normal

A low anion gap = alkaline – Hypoalbuminemia, Plasma cell dyscrasia, Monoclonal protein, Bromide intoxication, laboratory or intoxication with lithium, bromide, or iodide.

RFT (Renal function test)

Creatine is not Creatinine nor is it creatinine kinase.

CK tested on blood tests is a by product of exercise and energy production or tissue diestruction. Only measured as part of kidney test because kidney is supposed to remove it.

CK – creatinine kinase

WCC

WBCs help fight infections. They are also called leukocytes. There are five major types of white blood cells:

  • Basophils – A type of immune cell that has granules (small particles) with enzymes that are released during allergic reactions and asthma. A basophil is a type of white blood cell and a type of granulocyte.
  • Eosinophils – A type of immune cell that has granules (small particles) with enzymes that are released during infections, allergic reactions, and asthma. An eosinophil is a type of white blood cell and a type of granulocyte. (ESR = eosinophil sedimentation rate and is marker of inflammation)
  • Lymphocytes (T cells, B cells, and Natural Killer cells) A lymphocyte is a type of white blood cell that is part of the immune system. There are two main types of lymphocytes: B cells and T cells. The B cells produce antibodies that are used to attack invading bacteria, viruses, and toxins. The T cells destroy the body’s own cells that have themselves been taken over by viruses or become cancerous.
  • Monocytes – become macrophages to kill infections, phagocytic
  • Neutrophils – fight infection. A type of immune cell that is one of the first cell types to travel to the site of an infection. Neutrophils help fight infection by ingesting microorganisms and releasing enzymes that kill the microorganisms. A neutrophil is a type of white blood cell, a type of granulocyte, and a type of phagocyte.

Low WCC

  • Bone marrow deficiency or failure (for example, due to infection, tumor, or abnormal scarring)
  • Cancer treating drugs, or other medicines (see list below)
  • Certain autoimmune disorders such as lupus
  • Disease of the liver or spleen
  • Radiation treatment for cancer
  • Certain viral illnesses, such as mononucleosis (mono)
  • Cancers that damage the bone marrow
  • Very severe bacterial infections

High WCC

  • Aplastic anemia
  • Certain drugs or medicines (see list below)
  • Cigarette smoking
  • Not having a spleen, due to spleen removal
  • Infections, most often those caused by bacteria
  • Inflammatory disease (such as rheumatoid arthritis or allergy)
  • Leukemia
  • Severe mental or physical stress
  • Tissue damage (for example, burns)

Drugs that may lower your WBC count include:

  • Antibiotics
  • Anticonvulsants
  • Anti-thyroid drugs
  • Arsenicals
  • Captopril
  • Chemotherapy drugs
  • Chlorpromazine
  • Clozapine
  • Diuretics
  • Histamine-2 blockers
  • Sulfonamides
  • Quinidine
  • Terbinafine
  • Ticlopidine

Drugs that may increase WBC counts include:

  • Beta adrenergic agonists (for example, albuterol)
  • Corticosteroids
  • Epinephrine
  • Granulocyte colony stimulating factor
  • Heparin
  • Lithium

CRP

C-reactive protein (CRP) is a blood test marker for inflammation in the body. CRP is produced in the liver and its level is measured by testing the blood. CRP is classified as an acute phase reactant, which means that its levels will rise in response to inflammation.

Goes bad first and then comes good first. excellent marker for general tracking of aging etc. as it will change before BP, Blood sugar etc. change and then change good when on right track before the other stuff changes.

ESR

marker of inflammation

  • Unexplained fevers
  • Certain types of arthritis
  • Muscle symptoms
  • Other vague symptoms that cannot be explained
  • This test may also be used to monitor whether an illness is responding to treatment.
  • This test can be used to monitor inflammatory diseases or cancer. It is not used to diagnose a specific disorder.

However, the test is useful for detecting and monitoring:

  • Autoimmune disorders
  • Bone infections
  • Certain forms of arthritis
  • Inflammatory diseases that cause vague symptoms
  • Tissue death

 

Vitamin c enhances intestinal iron absorption by reducing nearly non-absorbable Fe3+ to more easily absorbable Fe2+. It also helps by inhibiting the production of insoluble iron-tannin (tannins are the compounds found in green and black tea that inhibit iron absorption) and iron-phytate (compounds found in fibre that can inhibit iron absorption) complexes.

Vitamin C also increases iron transfer from the iron transporting protein transferrin to the iron storage protein ferritin.

also needed for folate metabolism so anemia is common finding with vitamin c deficiency plus  elevated homo-cysteine