Liver and Digestion Complete

Checks your liver and pancreas, along with inflammation and the nutrient levels that drop when food is poorly absorbed.

The most common liver problem now is fat, not alcohol, and it is driven by insulin. So this panel reads the liver enzymes in the metabolic panel against fasting insulin, A1c, triglycerides and GGT, which together say whether a raised ALT is fatty liver, drinking, or something that needs imaging. Lipase and amylase cover the pancreas, the organ behind pain after eating that most often gets missed. High-sensitivity CRP and the sedimentation rate are the two inflammation markers, and when both are up alongside gut symptoms the question becomes inflammatory bowel disease. The second half of the panel asks whether the gut is absorbing what you eat. Iron, B12, folate, vitamin D, zinc and magnesium are the nutrients that fall first in celiac disease, in Crohn's, after stomach surgery and on long-term acid-blocking medication, and a deficiency in two or three of them at once is a stronger signal than any one. Prealbumin is a short-lived protein the liver makes that drops within days when nutrition is poor. Ceruloplasmin carries copper and is the screening test for Wilson's disease, a rare, treatable cause of liver damage in younger adults. The blood count shows what any of this has done to your red cells.

Blood is drawn at a Quest Diagnostics, Labcorp or BioReference patient service center. Price by laboratory: Quest Diagnostics $299, Labcorp $299 or BioReference $299. Your price depends on your state and the laboratories near you. Enter your ZIP code to see them.

What’s included

• Comprehensive metabolic panel (CMP): Glucose, sodium, potassium, chloride, carbon dioxide, calcium, the kidney tests BUN, creatinine and eGFR, total protein, albumin, bilirubin and the liver enzymes ALP, ALT and AST.
• Gamma-glutamyl transferase (GGT): Gamma-glutamyl transferase, an enzyme found mostly in the liver and bile ducts.
• Lipase: Lipase, an enzyme that helps digest fat, made mainly by the pancreas.
• Amylase: Amylase, an enzyme that helps digest starch, made mainly by the pancreas and salivary glands.
• Complete blood count (CBC): Red cells, white cells with a breakdown by type, and platelets, plus hemoglobin, hematocrit and red-cell size.
• Lipid panel: Total cholesterol, HDL cholesterol and triglycerides, with calculated LDL cholesterol, non-HDL cholesterol and the cholesterol-to-HDL ratio.
• Hemoglobin A1c: The percentage of hemoglobin with glucose attached, which reflects average blood sugar over about the past three months.
• Insulin: Insulin, the hormone that signals cells to take up glucose from the blood.
• C-reactive protein, high-sensitivity (hs-CRP): C-reactive protein, a protein the liver releases during inflammation, measured with a high-sensitivity method.
• Sed rate (ESR): How far red blood cells settle in an upright tube of blood over one hour (the erythrocyte sedimentation rate).
• Iron, TIBC and ferritin: Serum iron, total iron-binding capacity, iron saturation and ferritin, the body's iron-storage protein.
• Ceruloplasmin: Ceruloplasmin, a protein made by the liver that carries most of the copper in the blood.
• Prealbumin: Prealbumin (transthyretin), a protein made by the liver that helps carry thyroid hormone and vitamin A.
• Vitamin B12: Vitamin B12 (cobalamin) in serum.
• Folate: Folate (vitamin B9) in serum.
• Vitamin D (25-hydroxy): 25-hydroxyvitamin D, the main form of vitamin D circulating in the blood.
• Zinc: Zinc, an essential mineral, in serum or plasma.
• Magnesium: Magnesium in serum.

Tests you can add

• Apolipoprotein B (ApoB): Apolipoprotein B, the main protein on LDL and other cholesterol-carrying particles.
• Uric acid: Uric acid, a waste product of purine breakdown that the kidneys clear.
• Urinalysis: A urine sample checked for concentration, pH, protein, glucose, ketones, blood, bilirubin, nitrite and white cells, with a microscopic check.

Before your draw

Fasting required.

Fast for 9 to 12 hours before your draw; water is fine. The insulin test needs a fasting sample, and the lipid panel is best done fasting. Avoid alcohol for 24 hours before your draw. Ask your clinician whether to pause iron or B-vitamin supplements before the draw. If you take insulin or other diabetes medicine, ask your clinician how to take it while you fast. Don't stop your usual medicines unless your clinician tells you to. If you take biotin (vitamin B7), including in hair, skin and nail supplements or multivitamins, have your blood drawn at least 8 hours after a usual dose, or at least 72 hours after a high dose. If biotin was prescribed, ask your clinician before stopping it.