Do intense workouts lead to elevated liver enzyme levels?

Dr Philips explained that intense workouts, especially for those new to such routines, could significantly elevate liver enzyme levels.

ByChetana Belagere

Published Jun 04, 2024 | 6:57 AMUpdatedJun 05, 2024 | 12:41 PM

World Liver Day

Geetha, mother of 18-year-old Rakshith (name changed) was shocked when her son’s blood markers showed elevated levels of liver enzymes during a routine blood test.

These “off the charts” levels of aspartate aminotransferase (AST) and alanine transaminase (ALT) led the doctors to suggest a series of tests to determine its causes.

This scary and expensive ordeal lasted for a few days till a hepatologist observed the correlation of the patient’s elevated liver enzymes with a high-intensity workout regimen!

Kerala-based hepatologist Dr Cyriac Abby Philips — popularly known by his X handle TheLiverDoc/@theliverdr — posted about Rakshith’s case on the social media platform on Monday, 3 June.

“Please do not check liver tests right after a rigorous/high intensity work out especially if the work out/gym training was recently started. Exercise induced liver test changes and increase in liver enzymes in quite often overlooked and missed as a diagnosis by doctors. It often leads to unnecessary testing and panic,” he said on X.

Dr Philips is known for his expertise in liver health and his efforts to debunk common myths related to liver diseases. He advocates for evidence-based medical practices and works to educate the public on scientifically proven approaches to liver care.

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Elevated liver enzymes in 18-year-old

According to Dr Philips, since the 18-year-old’s blood markers showed high AST and ALT on the liver test, a series of tests were done to rule out rare liver diseases.

The family was asked to do imaging including CT and MRI scans from various hospitals and by multiple physicians over one week.

“Family is extremely worried as doctors were not able to figure out the cause for liver inflammation in the young male,” he said.

He said one physician recommended a liver biopsy, which made the family extremely worried. The doctor added that his scan reports were normal.

Intense exercise can up the liver enzymes

Dr Philips explained that intense workouts, especially for those new to such routines, could significantly elevate liver enzyme levels which is often overlooked or misdiagnosed by doctors.

He noted that the youngster’s reports were abnormal after “leg days” when the training was quite intense.

According to studies, these elevations are generally benign and reflect muscle damage rather than liver pathology.

“Exercise-induced liver test changes and increase in liver enzymes is quite often overlooked and missed as a diagnosis by doctors. It often leads to unnecessary testing and panic,” he said.

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When to do Liver Function Tests?

Dr Philip said that in cases like the one cited above, a period of rest, good hydration during workouts and a stepwise increment in exercise schedule would make the liver function test results within a few weeks.

He also referred to a paper in the Journal of Family Medicine and Primary Care, a case study of an asymptomatic, non-alcoholic person, without any personal or family history of liver disease, showing elevated liver enzyme levels.

The liver function test reports of a healthy 39-year-old man had revealed enzyme levels of 1.4-2.3 times the normal limit.

After several tests including abdominal ultrasound, hepatitis A, B and C, M proteins and antimitochondrial antibodies, repeat LFTs and a liver biopsy the patient was asked to abstain from exercise for seven days and perform the LFTs.

Interestingly, the following reports were normal.

The authors concluded that the abnormal liver panel was likely due to exercise-induced muscle damage and/or changes in hepatocyte membrane permeability.

The researchers highlighted the knowledge gap in primary care regarding the possible causes of LFT abnormalities at a young age.

Citing the possible reasons, the authors stated, “Exercise can also influence liver function directly. For instance, decreases in hepatic blood flow and oxygen saturation during strenuous exercise can increase hepatocyte membrane permeability and subsequently raise liver enzymes.”

The authors also said that γ-glutamyltransferase (GGT) has been observed to increase acutely from baseline following participation in half-marathons, despite other values not exceeding the upper limit of normal.

Dr Philips added that the young man was doing fine with normal liver tests.

(Edited by Muhammed Fazil)