FEATURE Correlation of Zinc and Alkaline phosphatase Correlation of Mg and Alkaline phosphatase Alkaline phosphatase Magnesium Zinc Alkaline phosphatase Fig.1: Correlation of Zn and Alkaline Phosphatase Ray et al., Curr. Res. Nutr Food Sci Jour., Vol. 5(3), 347-352 (2017) Fig. 2: Correlation of Mg and Alkaline Phosphatase alcohol-related liver disease. I have seen many patients come in with an elevated GGT and have been told by their phy-sician to reduce or stop their alcohol consumption. This is often a significant source of frustration as most of them are not consuming excessive amounts. GGT data has been collected by the life insurance industry for many years. Their principal reason for measuring GGT levels was the ability to mark alcohol abuse or risky drinking behaviour in life insurance applicants. When high GGT levels were found in life insurance candidates, premium policy pricing or even application rejection often resulted. xi Although gamma-glutamyl compounds include antioxi-dants, inflammatory molecules, drug metabolites, and reac-tive compounds, the major function of GGT is enabling metabolism of the antioxidant glutathione and is a marker for glutathione depletion in the liver. Elevations in GGT reflect increased exposure to organic xenobiotics that are metabolized in the liver through glutathionylation. xii Elevations in GGT can be seen in conditions well beyond liver disease: Elevated GGT is linked to increased risk to a multitude of diseases and conditions, including cardiovas-cular disease, diabetes, metabolic syndrome (MetS), and all-cause mortality xiii Changes in GGT concentrations have been reported in a wide variety of clinical conditions, in-cluding pancreatic disease, myocardial infarction, renal failure, chronic obstructive pulmonary disease, diabetes, and alcoholism. xiv Liver function tests (principally GGT and ALP), hypocholesterolemia, proteinuria, and low fruc-tosamine were found to be independently predictive of cancer mortality. GGT-ALP ranked highest for predicting mortality risks for all men in age groups 18 through 59 years. For women, GGT-ALP was ranked first for those aged 30 through 59, and second behind urine protein and urine creatinine for ages between 60 and 79 years. xv Palmier and Lanzrath xi calculated a hazard ratio (HR) curve for males with an increasing HR trend starting at about 0.70 to 0.80 for GGT between approximately 15 U/L and 20 U/L that became a fairly flat curve between GGT levels of approximately 45 U/L to 85 U/L. The lowest GGT-related risk quartiles were less than 16 20 Chiropractic and Naturopathic Doctor November/December 2021 The key is recognizing the inherent weakness in reference ranges. U/L for men and 10 U/L for women. Above these reference levels, increasing GGT levels translated to increased risks for each outcome studied and reached statistical significance for CHD mortality among men with GGT levels above the male median level of 24 U/L For women, CHD mortality risk reached a significant HR of 1.65 with GGT of 20–32 U/L. Threshold GGT levels at which higher CHD mortality risk became significant for both men and women were GGT 16–24 U/L A large Austrian study also demonstrated an approximate doubling of HRs between low to high GGT levels for cancer mortality. xvi SUMMARY This article was not intended to be an exhaustive review of optimal values for blood values or clinical interpretation of them, but to demonstrate the limitations of the standard approach to assessing blood work and encourage the reader to consider a more nuanced and individualized approach. There are numerous resources for exploring the interre-lationships between biomarkers and functional blood chem-istry analysis. Some examples include: 1. Intermountain Risk Score: https://intermountainhealth-care.org/IMRS/ 2. MediCalc: http://www.scymed.com/en/smnxab/smnx-abaa.htm 3. The Medical Algorithm Company: https://www.medi-calalgorithms.com/ 4. Health & Medical Calculators: https://www.thecalculator. co 5. OPTIMAL Dx: https://www.optimaldx.com/ Using basic blood chemistry can be a familiar, low cost www.Cndoctor.ca
Chiropractic + Naturopathic Doctor November/December 2021: Page 20
