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c/bloodwork·posted 3 months ago by u/edit_for_clarity

[Meta] the ALT rule is doing its job and people should stop complaining

Question Receipts ×2 Well Actually ×3

the ALT rule is doing its job and people should stop complaining. Comments open, and the wording is genuinely up for discussion.

Added ApoB to the panel after a thread here. It told me something the standard lipid panel had been hiding.

My ApoB moved and I spent a fortnight convinced I knew why. The repeat six weeks later was back in range and I had changed nothing.

Repeat testing before acting is standard practice for a reason: regression to the mean does a lot of work on single outlying values.

That is everything I have. The rest is opinion and I have tried to keep it out.

5,051 up / 3,712 down58% upvoted46 commentsid 1id1m726 Apr 2026

46 comments

18 in this archive, depth 5

best — the order this archive was captured in

u/hedda_adeyemi163 points·3 months ago

Time of day, fasting state, hydration and recent exercise all move common markers. Standardising the draw conditions is free and it removes most of the apparent variability.

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u/constipation_clubside effects-34 points·3 months ago

Why so many single values look alarming and turn out to be nothing.

A reference interval is built to contain about 95% of a healthy reference population, so one test in twenty falls outside one by construction. Add biological variation, assay imprecision, fasting state and time of day, and a genuinely stable person will produce occasional out-of-range results.

That is why repeat testing before acting is standard. Regression to the mean handles most of it. None of which means an out-of-range value should be ignored — it means it should be repeated and taken to somebody who can put it in context, which is emphatically not a ranked feed.

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u/liver_enzyme_liz1 point·3 months ago

nothing on this board interprets your results for you

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[removed]1 point·3 months ago

[removed by moderator]

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u/edit_for_clarityOP1 point·3 months ago

Correcting my own comment: the two draws were 9 weeks apart, not the figure I gave earlier.

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u/mariam_mensa74 points·3 months ago

Right, and weight loss itself moves several markers, so attribution is harder than these threads assume.

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u/liv_okafor46 points·3 months ago

Right, and weight loss itself moves several markers, so attribution is harder than these threads assume.

Adding the obvious one — take it to whoever ordered the panel. This board cannot read it for you.

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u/jarno_karlsen12 points·3 months ago

draw at the same point in the week if you want comparability

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u/edit_for_clarityOP5 points·3 months ago

Panicked about a single result, posted here, got told to repeat it, repeated it, and it was fine.

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u/pavel_nkemelu4 points·3 months ago

same lab, same conditions, or you are comparing noise

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u/kaia_kuusela3 points·3 months ago

Small fix — a reference interval is not a treatment target, and the post above uses them interchangeably.

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u/thermal_mass_tom23 points·3 months ago

baseline before you start is worth more than any later panel

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u/edit_for_clarityOP18 points·3 months ago·edited

Is that the same assay, or did the lab change platforms?

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u/milos_trevino8 points·3 months ago

the trend line matters more than any single value

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u/hedda_adeyemi14 points·3 months ago

Disagree with reading anything into that. One value, one morning, and you changed two other things in the same window.

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u/valeria_karlsen59 points·3 months ago

a single hs-CRP outside range is a reason to repeat, not to panic

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u/isabela_guerrero20 points·3 months ago

Same view — ApoB if you add one thing. It answers a question the standard panel only gestures at.

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u/step_therapy_s5 points·3 months ago

bring the numbers to someone qualified to read them

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About c/bloodwork

What to measure before you start, what to re-measure, and how to interpret movement without panicking. ApoB over LDL-C, HOMA-IR as a crude free tool, ALT and the fatty-liver story, eGFR noise during rapid loss, and the deficiencies that a 1,100-calorie appetite will hand you.

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