Albumin/Globulin Ratio
Liver Function marker
A/G Ratio
Albumin/Globulin Ratio
Calculated ratio of serum albumin to globulin. Reflects the balance between hepatic synthetic function and immune/inflammatory protein production.
PED Notes
Oral 17-alpha-alkylated AAS can increase hepatic albumin synthesis, potentially raising the ratio. If hepatotoxicity progresses, albumin drops and the ratio falls. Intense training stimulates albumin synthesis during recovery. High-protein diets support albumin production. Chronic inflammation from overtraining or joint injuries elevates globulins, lowering the ratio. Dehydration concentrates all proteins but can disproportionately affect the ratio. Interpret alongside albumin, globulin, total protein, and liver function markers.
Understanding A/G Ratio:
- A/G Ratio = Albumin / (Total Protein - Albumin)
- Normal ratio means albumin predominates over globulins (expected healthy state)
- Low ratio (<1.0) → either albumin is low (liver dysfunction, malnutrition) or globulins are high (inflammation, infection)
- High ratio (>2.5) → may indicate immunodeficiency or dehydration
If Low (<1.0):
- Check albumin and globulin individually to determine which is driving the ratio
- If albumin is low → investigate liver function (ALT, AST, GGT, bilirubin) and nutritional status
- If globulins are high → check CRP, ESR for inflammation
- Oral 17-alpha-alkylated AAS can cause cholestatic liver injury reducing albumin — consider discontinuing orals
If High (>2.5):
- Most commonly dehydration — retest after 48 hours of adequate hydration (3-4L/day)
Supplements:
- NAC -- 600-1200mg/day (supports hepatic glutathione)
- TUDCA -- 250-500mg/day (if on oral AAS)
- Milk Thistle (Silymarin) -- 200-400mg/day (hepatoprotective)
Lifestyle:
- Ensure adequate hydration before blood draws
- If on oral AAS, limit cycle length and use liver support throughout
- Monitor alongside total protein, albumin, and globulin individually
References:
- Busher, J. T. (1990). Serum albumin and globulin. In H. K. Walker, W. D. Hall, & J. W. Hurst (Eds.), Clinical Methods (3rd ed., Chapter 101). Butterworths. Available from: https://www.ncbi.nlm.nih.gov/books/NBK204/
- Chi, J., Xie, Q., Jia, J., et al. (2018). Prognostic value of albumin/globulin ratio in survival and lymph node metastasis in patients with cancer. Journal of Cancer, 9(13), 2341-2348. DOI: 10.7150/jca.24889
- Hoffman, J. R., & Falvo, M. J. (2004). Protein — which is best? Journal of Sports Science & Medicine, 3(3), 118-130. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3905294/
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