🫀 Fatty Liver & Liver Health
For everyone · 8 markers · $291.15
with code CAMERON $323.50
Raised liver enzymes on a routine panel, a fatty liver mentioned on a scan, heavy drinking, oral compounds, or metabolic syndrome.
🩸 Order this exact panel — 10% off
All 8 markers load into your cart in one click. No doctor's visit, drawn at any Quest location in the US, results by email in about two weeks. Code CAMERON applies automatically.
Add all 8 markers — $291.15 → Open the full Bloodwork Vault →Why this panel
Fatty liver is now the most common liver disease in the world and it is largely silent. Enzymes alone can't tell you whether there's scarring — which is the only part that really determines outcome.
What this panel can settle, and by what logic
Eight markers, one of which costs $250. What the combination settles is the only question in fatty liver that changes an outcome: is there scarring, and how fast is it accumulating?
- The Comprehensive Metabolic Panel (CMP) and the Complete Blood Count (CBC) with Differential together already contain a fibrosis score, and it is free. FIB-4 is calculated from age, AST, ALT and platelet count — every input is on this panel. The evidence for using it is specifically as the first step of a sequence, with a fibrosis blood test used second in the people FIB-4 cannot classify Kang 2024. Nobody tells buyers this, and it means the $73 half of the panel answers the first question on its own.
- Enhanced Liver Fibrosis (ELF) Test is the second step, and it is worth its price only in that position. It estimates matrix turnover directly rather than inferring it from enzymes, and it held its diagnostic accuracy for fibrosis in real-world practice rather than only in trial cohorts Kang 2024.
- Ferritin read with Fasting Insulin, HbA1c (Hemoglobin A1c) and the triglycerides is a defined entity, not a stray high number. A raised ferritin with metabolic dysfunction and no genetic iron loading is metabolic hyperferritinemia, which has an agreed definition and a different work-up from hemochromatosis Valenti 2023.
- The platelet count on the Complete Blood Count (CBC) with Differential is the early structural signal. A platelet count drifting down over years, while every enzyme stays normal, is portal hypertension developing, and it appears before anything else on this list moves.
What it cannot settle, and what would
It cannot stage fibrosis, and no blood test can. Enhanced Liver Fibrosis (ELF) Test and FIB-4 estimate the probability of advanced fibrosis; they do not produce a stage, and the sequential approach exists precisely because each of them leaves a band of people unclassified Kang 2024. Staging is done by transient elastography and, where that is equivocal, by biopsy.
A normal ALT does not mean a normal liver, and this is the misreading the panel exists to prevent. In middle-aged adults with overweight whose liver enzymes were inside the reference interval, steatotic liver disease was present in 42% van Son 2024. ALT is still worth watching — cumulative high-normal values track incident steatotic liver disease Lonardo 2024 — but as a screen for fat it fails in most of the people who have it.
It cannot see fat at all. Nothing here measures steatosis directly. Ultrasound sees it crudely, and an MRI-derived proton density fat fraction measures it as a percentage. If the question is “how much fat is in my liver and is it going down”, this panel is not the instrument van Son 2024.
And it cannot tell you the cause. There is no hepatitis B or C serology on this list, no autoimmune panel, no ceruloplasmin, no alpha-1 antitrypsin. Metabolic and alcohol-related disease also look identical here; the GGT on a fuller chemistry helps and is not diagnostic. Anyone with persistently abnormal enzymes needs the viral serology, and it is not a marker this panel replaces.
Draw conditions that decide whether the money is wasted
Two of the instructions on this panel are unusually expensive to ignore, because the enzymes they protect are the ones people act on.
- No alcohol for 72 hours. A single heavy evening lifts GGT and can lift AST, and the result is indistinguishable on the report from chronic injury. This is the instruction most often skipped by the people who most need the panel Lonardo 2024.
- No hard training for 72 hours, and none at all if you lift. AST and ALT are both present in skeletal muscle, so a heavy session raises them without any liver involvement. The tell is the ratio: muscle-derived rises push AST proportionally harder than ALT and leave GGT untouched, whereas a metabolic liver picture usually runs ALT above AST.
- Fast 9 to 12 hours. Triglycerides track liver fat and are meaningless fed; Fasting Insulin is the marker that explains the rest of the panel and is fasting by definition.
- Not within 2 weeks of any illness. Ferritin and hs-CRP (High-Sensitivity C-Reactive Protein) both rise as acute-phase proteins Luo 2023, and an inflamed ferritin produces exactly the pattern that would otherwise be read as metabolic hyperferritinemia Valenti 2023.
How you would know it answered your question, and what each pattern means next
Read this panel in a sequence rather than as eight results. Each branch has a different interval and a different next spend.
- FIB-4 low and Enhanced Liver Fibrosis (ELF) Test low: advanced fibrosis is unlikely and the sequence has done its work Kang 2024. Repeat the cheap half — Comprehensive Metabolic Panel (CMP), Complete Blood Count (CBC) with Differential, HbA1c (Hemoglobin A1c) — in 12 months, and do not buy the $250 marker again in the meantime.
- Enhanced Liver Fibrosis (ELF) Test raised: this is a hepatology referral, not a retest. The confirmatory step is elastography, and it is not something another blood panel improves on Kang 2024.
- Enzymes raised with a low FIB-4 and a high Fasting Insulin: the common picture, and the reversible one. Retest the enzymes at 12 weeks with 72 hours of no alcohol and no training beforehand — hepatic fat responds to weight and metabolic change over months, and a 4-week recheck is too early to show it Lonardo 2024.
- Ferritin raised with a normal hs-CRP (High-Sensitivity C-Reactive Protein) and metabolic markers out of range: read it as metabolic rather than as iron overload Valenti 2023. A transferrin saturation is the cheap test that separates the two; a hemochromatosis genotype is not the first move.
- Falling platelets across two panels: the finding on this list that outranks the enzymes. Take it to a doctor regardless of what Enhanced Liver Fibrosis (ELF) Test said, because it is a structural signal and the blood tests here are probabilistic ones Kang 2024.
Sources read for these sections
- Kang YW, et al. Sequential Diagnostic Approach Using FIB-4 and ELF for Predicting Advanced Fibrosis in Metabolic Dysfunction-Associated Steatotic Liver Disease. Diagnostics (Basel) 2024 · PMID 39594183
- van Son KC, et al. Prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) in a middle-aged population with overweight and normal liver enzymes, and diagnostic accuracy of noninvasive proxies. Medicine (Baltimore) 2024 · PMID 38181294
- Lonardo A. Alanine aminotransferase predicts incident steatotic liver disease of metabolic etiology: Long life to the old biomarker!. World Journal of Gastroenterology 2024 · PMID 38983954
- Valenti L, et al. Consensus Statement on the definition and classification of metabolic hyperferritinaemia. Nature Reviews Endocrinology 2023 · PMID 36805052
- Luo H, et al. A Practical Guide to Adjust Micronutrient Biomarkers for Inflammation Using the BRINDA Method. Journal of Nutrition 2023 · PMID 36792034
The 8 markers — and why each one is here
Falling platelets is an early sign of advanced liver disease
Ordering the panel tells you your numbers. The protocol tells you what to do with them — why a normal ALT doesn't rule it out, the free FIB-4 score you can calculate from labs you already have, and the weight-loss thresholds where fibrosis actually reverses.
Join Skool — $10/mo →What this panel is ordered to decide
A panel is a set of numbers until it settles something. These are the decisions this one feeds — each links the pathway it belongs to, what that pathway claims, and what its test list is read for.
Before assuming toxins, rule out the two inherited causes of liver injury that are common and completely missable: hemochromatosis (iron) and Wilson's disease (copper). Both are one test each.
A GGT rising with a raised MCV is the classic alcohol pattern and shows up long before anything else does. Thiamine matters most: deficiency causes permanent neurological damage and is trivially preventable.
An ALT above 30 with insulin resistance is fatty liver until proven otherwise, even inside the 'normal' range — the reference range was set on a population that largely had it. The ELF score estimates fibrosis without a biopsy.
Related panels
Frequently asked questions
8 markers: Comprehensive Metabolic Panel (CMP), Enhanced Liver Fibrosis (ELF) Test, Ferritin, Insulin (Fasting), HbA1c (Hemoglobin A1c), Lipid Panel, Complete Blood Count (CBC) w/ Differential, hs-CRP (C-Reactive Protein, High Sensitivity).
$323.50 before discount, $291.15 with code CAMERON applied automatically. Individual markers add a one-time $10 draw fee. Ordered through Marek Diagnostics and drawn at any Quest Diagnostics location in the US.
No. These are ordered direct-to-consumer through Marek Diagnostics — you order online, walk into a Quest location, and results are emailed to you in about two weeks. No physician visit or insurance required. Not available in NY, NJ or RI.
Fast 9–12 hours. No alcohol for 72 hours and no hard training for 72 hours — both distort enzymes badly enough to change your interpretation.
Enzymes above 3× the upper limit that persist when rested and sober need a doctor. A raised ELF score warrants hepatology referral. Normal ELF with mildly raised enzymes and high insulin is the common picture, and it's reversible with weight and metabolic change.
Where this goes next
This page is how to read the panel. What to DO about each result — the dosing, the order to correct things in, the week-by-week schedule and what to retest — is a lesson inside Skool.