By doctor Francesco Casillo
How many times has it happened that, after having found high transaminase values, the doctor or whoever warned him about the possible stress hepatic? They are the values out range (with respect to the reference) of the transaminases sign and prediction of stress hepatic? The answer is "ni"!
If it is a subject who trains vigorously "they may" be, but they are not marker hepatic stressor prediction absolutes - why will be explained shortly below; if, on the other hand, they are sedentary subjects, they are very likely! (The transaminases could also be elevated in other circumstances: myocardial infarction and taking herbal preparations or drugs and in other conditions, but here they are not taken into consideration, as they go beyond the mere aim of highlighting how elevated values can be found also in conditions of full health and not necessarily in conditions of stress liver, as the mass knowledge wants).
ALT (GPT) and AST (GOT) are liver enzymes (more commonly known as "transaminases"). Their movement is interpreted as a sign of liver pain as they are present in the liver. The connection that is overlooked is that these enzymes are also present in other tissues, including the musculoskeletal one. In fact, tissue alterations such as micro-lesions on muscle tissue induced by vigorous training determine their movement, shifting their values out of the range of reference; the lack of knowledge of their localization, including musculoskeletal, and the non-consideration of the entirety of the patient's clinical picture and lifestyle inevitably lead to unfounded alarms.
In an in-depth study, Dr.Rob Dickerman of the University of North Texas Department of Medicine collected ALT, AST, CK and Gamma GT hematology tests from five categories of subjects: body-builder who used anabolic steroids, natural body-builder, patients with liver disease (viral hepatitis), trained students and sedentary students. The results were unequivocal: ALT and AST were elevated in all body-builder, whether or not they used anabolic substances. The Gamma GTs (sensitive marker of liver damage) were elevated above range of reference only in people with ongoing liver disease. Creatin Kinase (CK), an enzyme that rises in response to musculoskeletal tissue damage, was elevated in all groups that involved training protocols - without, however, they reported any damage or stress to the liver. Furthermore, CK was highly correlated with ALT and AST levels.
The typical resistance training of body-building, causing musculoskeletal damage, elevates ALT and AST which are also found in muscles and which, therefore, can easily be confused as a sign of stress or liver disease if we do not also consider other values that give a more precise picture of the tissue substrate from which the observed enzymatic increase derives. Therefore, the meaning of the elevation of ALT and AST values may be different, depending on whether the subjects observed are athletes (subjected to particular training regimes inducing muscle micro-injuries, as in the case of bodybuilders) or sedentary.
Other articles on "High Transaminases in Sports"
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- High-protein diet and kidney damage
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