Are Low Values of Liver Enzymes Concerning?

General Health

Dec 17

More Programs and Publications Featuring Dr. Kyle Riding

In this program:

Liver function tests (LFTs) include looking at ALT, ASP, and ALP enzyme levels. Watch as medical laboratory scientist Dr. Kyle Riding shares insight about what low liver enzymes can mean and cases when low levels can be medical concerns.

Transcript

Leo Hesse:

Now, Dr. Riding, with many laboratory tests, we tend to be concerned about results that are either very high or very low, and you mentioned a while ago high liver enzymes are concerning. Should we also be concerned about low values?

Dr. Kyle Riding:

That is a great question, and something that patients get very anxious over a lot is they get their lab results back for an LFT to test, and they see that their ALT or their ALP is low and they go, “Oh my goodness, should I be concerned about this?” And I'm here to reassure you that in a vast majority of clinical scenarios, low liver enzymes, so low levels of ALT, AST, or ALP are not anything to worry about, all right? Take it back to how we created reference ranges. We take a healthy group of people that we can find volunteers for us at our hospital, we draw their blood and we develop using statistical techniques, a range that covers about 95 percent of that healthy population’s results for each of those lab tests. So there's going to be 5 percent of the population that is going to fall outside of that range that will be perfectly healthy just based on the statistical way we make the reference ranges, and biologically speaking, liver enzymes are concerning when they're high, because that means those liver cells are rupturing and those enzymes are spilling over into the block, but when the liver enzymes are low, it could just simply mean that this patient doesn't have a lot of liver cells turning over, meaning they're dying and being replaced, or it simply means that their liver enzymes are just lower.

And that's healthy for them. There's only one major clinical scenario where low liver enzymes is a concern, and that's in end stage liver disease or liver cirrhosis, where the liver has become so filled with scar tissue that there's no longer really enough liver cells to produce any of those enzymes. But I will tell you, if you are in that level of liver cirrhosis, the low liver enzymes is going to be the least concerning of the laboratory results that you have, so just to kind of put the ball now, high liver enzymes are really what we're concerned about, low liver enzymes typically are nothing to be concerned about. But if you're ever concerned, you're ever anxious, it's important to always talk to your provider and find out what they could need to do in your unique situation.

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