Liver Support

[heavyiron]

Looking After Your Liver!
Written by Leigh Penman
Friday, 13 February 2009 23:18


If you have used oral steroids you will no doubt be familiar with the term c-17-alpha alkylated. This refers to the chemical alteration that enables the steroid to survive the first pass through the liver - allowing nearly all of the drug to enter the bloodstream. Now, while this is good on paper, the fact is that prolonged exposure to c-17-alpha alkylated drugs (which most orals are) can put a serious strain on the liver. It is for this reason that oral cycles should be restricted in length (usually less than 8 weeks) and liver enzyme values should be kept in check via blood work.

The first visible sign of an agitated liver is jaundice (bile duct obstruction), which produces an unusual yellowing of the skin. In addition to this, the whites of the eyes may also take on a yellow hue. If this occurs, the use of the oral compound should be terminated and a doctor consulted before some serious damage is done. Now before you all panic and rush to the mirror to examine your eyeballs, it has to be said that most oral steroids are generally safe just as long as they are not abused (i.e. taken in excessive dosages) or taken for extended periods of time. However, if you are planning to use, or are already using, oral compounds it is important to at least posses a layman's knowledge of monitoring and maintaining liver health. So, with this in mind let me introduce you to ....



THE LIVER PANEL

When having your blood work done it is important to have a full liver panel conducted. This is extremely important since it will reflect any level of hepatic strain. With this in mind, it is a good idea to have this done before you begin any steroid cycle. The reason for this is to give you a baseline reading which is important for obvious reasons - how do you know if your liver enzymes are elevated if you don't know what they were before you started your cycle. The markers that we are most interested in when it comes to assessing liver health are ALT, AST, ALP, GGT and Bilirubin. That being said, let's take a closer look at these important indicators, starting with:



ALT and AST

These two enzymes are necessary to the metabolism of amino acids and protein in the liver and, should the liver be subject to any damage, they will leak into the blood stream. ALT (alanine aminotransferase) and AST (aspartate aminotransferese) are considered to be important indicators of liver toxicity due to steroid use. Should they be significantly elevated during a cycle then it is definitely time to stop that cycle!



Reference ranges for ALT and AST are:

ALT (SGPT): 0-55 iu/l
AST (SGOT): 0-40 iu/l
It should also be noted that cases of liver damage have been recorded independent of elevation of these enzymes. So, whilst they are important, you should not make them your sole indicator of liver stress/damage.



ALP and GGT

Elevations in ALP( alkaline phosphatase) and GGT (gamma-glutamyl-transpeptidase) can be indicative of bile duct obstruction. This is an indicator of serious steroid induced liver toxicity and should never be dismissed. Levels of a substance known as Bilirubin should also be measured. Bilirubin is a yellow fluid found in bile and is responsible for the yellowing of the skin and eyes associated with bile duct obstruction.

Reference ranges for ALP, GGT and Bilirubin are:

ALP: 25-150 iu/l
GGT: <50 mol/l
Bilirubin: 0.1-1.2 mg/dl


IMPORTANT NOTE
It is important to note that slight elevations of ALT and AST can be the result of exercise induced muscle damage rather than liver toxicity. This is why it is important to obtain a pre steroid use baseline reading. Elevations following steroid use would then be an accurate reflection of the effect the steroids are having on the liver and an indication that steroid use should be terminated in order to avoid further liver damage.



NATURAL LIVER SUPPORT

There are a number of natural compounds which are reputed to have protective effects on the liver and, if considering the use of or already using oral steroids, it is wise to employ them. The most popular natural liver protector is Silymarin (milk thistle) although NAC (N-acetylcysteine) and gluthionine may also be of value. In addition to this a product called ‘Essentiale Forte N' (available in tablet and injectable form) which contains vitamins B, E, PP as well as Linoleic, Linolenic and Oleic Acids is also worthy of your consideration.

[heavyiron]

Liv 52 is another amazing supplement for liver health. There are hundreds of studies showing its effectiveness.

http://liv52.com/

[heavyiron]

Liver Scare With OTC Steroids

The prohormone, prosteroid or designer steroid market (whatever you like to call it) has been a persistent and strong area of sports nutrition for years now in spite of past legislation aimed at curbing it. It has also been a very controversial market, with many consumers applauding the companies willing to sell quality and effective products, and yet many more opposing such business. It is another war over steroids if you will— a war that is still being fought right now. Well, the Journal of Clinical Gastroenterology and Hepatology published an article this month concerning two stories of severe liver toxicity with the use of over-the-counter (OTC) designer steroid products, and it is an article sure to inflame many on both sides of the issue. The paper itself is a review, which essentially means that it is reporting on the results of other medical papers or articles. This one happens to detail two separate incidents of severe liver toxicity that were reported independently of one another. The specifics of the two individual cases were provided in the medical review, and are discussed below, along with my follow-up comments.

Patient 1

The first patient of discussion was a 40-year-old male bodybuilder. He was admitted to Johns Hopkins University in April 2006 after noticing such symptoms as jaundice, weakness, dark-colored urine and weight loss. The patient reported that the symptoms had begun approximately four to five weeks before admittance to the hospital, during which time they became progressively worse. He reported using a commonly available OTC designer steroid at a dosage of 20mg per day. The particular compound used was a c-17 alpha methylated derivative of drostanolone/Masteron. This alteration is common to many oral steroids, as it is a way to make them more bioavailable. It also causes them to place some strain on the liver. The patient reported using the product for a total of six weeks. The only other drug or supplement he reported taking was a multivitamin and a protein powder.

Upon admittance to the hospital, the patient had excessively elevated markers of liver stress. This included seriously elevated bilirubin (50 mg/dl), alanine aminotransferase (301 U/L), aspartate aminotransferase (121 U/L) and alkaline phosphatase (416 U/L) levels. Tests for hepatitis A, B and C, and Epstein-Barr virus were negative, as was a series of other tests, ruling out other common factors in hepatic disease. The patient also had visible yellowing of the eyes due to the buildup of bilirubin, a common sign that significant stress is being placed upon the liver. MRI imaging confirmed that the patient had lobular cholestasis, a condition where the flow of bile becomes inhibited. After an eight-week period of supportive therapy and steroid discontinuance, the patient recovered without need for a liver transplant. Upon his last checkup, his bilirubin had returned to a level of 2.9 mg/dl.

Patient 2

The second report was of a 32-year-old patient, also a male bodybuilder. He was initially reporting flu-like symptoms, as well as weakness, jaundice and rapid weight loss totaling 30 pounds. He claims to have used two different steroids for a period of four weeks, although the exact dosages were not disclosed. The first drug was the same methylated Masteron derivative as in the first report. The second was also a c-17 methylated drug, this one a close chemical analog of chlorodehydromethyltestosterone (Oral-Turinabol). In addition to these anabolic steroids, the patient was also being treated for anxiety with Zoloft. He was a regular smoker and drank excessively on occasion. The patient denied having any history of liver disease.

Upon admittance, the patient also had excessively elevated markers of liver stress. This included bilirubin levels of 37.6 mg/dl, alanine aminotransferase of 59 U/L, aspartate aminotransferase at 55 U/L and alkaline phosphatase of 375 U/L. As with the first patient, an extensive panel of tests was run to rule out other causes of hepatic stress. Liver biopsy revealed centrilobular cholestasis. Supportive treatment was given, and the patient slowly recovered over a period of 15 weeks. Doctors noted that the liver strain did not appear to be of the type caused by either alcohol or Zoloft use, and resembled that of other documented cases of oral steroid toxicity. The fact that it was resolved with steroid cessation further supported this conclusion. As with the first patient, recovery appeared to be complete without the need for extreme intervention. Upon his last checkup, the individual’s bilirubin levels returned to a very normal 1.2 mg/dl.

Comments

The paper in question details two strong examples of the potential for liver toxicity with oral anabolic steroids. Both cases were resolved without serious lasting injury, however. The potential hepatotoxicity of methylated oral steroids is really not in question. Oral steroids have been studied for decades, and are well understood at this point, at least in a general sense (the two specific drugs in question were never tested on humans in a medical setting before). Reports of similar hepatic stress can be found with such approved medications as oxymetholone, methandrostenolone, stanozolol and methyltestosterone (along with other drugs of this class). So in the grand scheme of things, the news is not really that shocking at all, but to be expected on rare occasion with the use of these medications.

On the one hand, this paper is sure to be used as ammunition on those trying to eliminate the legal steroid market. After all, if a case can be made that these drugs are extremely and immediately dangerous to the public, action is going to be more rapid from the government. Nothing gets politicians moving like hot drug topics— especially these days. At the same time, those familiar with the drugs and issues are likely to say that these two isolated reports are just that, isolated. Were the compounds so very dangerous, as the argument would go, there would be many more reports of injury given their present popularity. Since both papers relied on the individual reports of the patients themselves, exact specifics about their use (or misuse) cannot be verified. If any conclusion can be drawn I think it is a simple one: OTC designer steroids are in the same family as prescription oral steroids. While they may be sold openly in stores, they are no less (and probably no more) dangerous than those behind the pharmacy counter. They need to be respected as such, and all users need to be aware that toxicity as described above is very possible with use, even if in reality it is not very common.