Liver Health

PQ: It is important to stress that while life-threatening injury from oral steroid use is admittedly very rare, these issues do legitimately occur in otherwise healthy bodybuilders and should be taken seriously during your regular health screenings.

As some readers may be familiar, most oral steroids are c-17-alpha alkylated compounds. This is a chemical alteration that allows a steroid to survive its first pass through the liver and into the bloodstream. Unfortunately, however, c-17 alkylation can place a good amount of strain on the liver in the process. While oral steroids are generally regarded as fairly safe in a medical sense, the abuse of these drugs can lead to serious liver damage (even cancer or death) in rare cases. If you are using a lot of oral anabolic steroids, or plan on using them, then it is important to understand a bit about monitoring and maintaining liver health. In this article, I’d like to review some of the basics of lab testing (blood work) and discuss the potential for liver support supplements to help maintain liver health. An obligatory rundown of the more serious consequences of oral steroid abuse is also in order. It is important to stress that while life-threatening injury from oral steroid use is admittedly very rare, these issues do legitimately occur in otherwise healthy bodybuilders and should be taken seriously during your regular health screenings.

The four most common serious manifestations of steroid-induced liver toxicity are intrahepatic cholestasis, peliosis hepatis, hepatocellular adenoma and hepatocellular carcinoma. Intrahepatic cholestasis refers to a condition where the liver can no longer properly transport and metabolize bile (bile duct obstruction). This may coincide with jaundice, or a yellowing of the skin and eyes as bilirubin builds in body tissues. Cholestasis is usually resolved with the immediate cessation of steroid use. Peliosis hepatis is a rare and very serious condition characterized by blood-filled cysts on the liver. Hepatocellular adenoma is a rare non-malignant (non-cancerous) liver tumor. While in some cases it may require no further intervention other than abstinence from steroid use, hepatocellular ademona can lead to life-threatening bleeding or liver failure. Hepatocellular carcinoma refers to malignant liver cancer. This last and perhaps most serious consequence of steroid use has only been documented in one previously healthy recreational steroid user.

Liver Support Supplements

Aside from testing, the hepatic strain of oral steroid use may be reduced with the use of certain liver support supplements. While it may seem counterintuitive to use a dietary supplement to offset the side effects of a hepatotoxic drug, there is an increasingly large body of evidence supporting the use of certain natural compounds for this purpose. Nutritional products like silymarin and Liv-52 (a blended liver support supplement) have become increasingly common in the steroid-using community as of late, largely based on a growing number of medical studies demonstrating their ability to protect the liver from toxins like drugs, alcohol and certain chemicals. The ability for these products to help reduce actual steroid toxicity seems to be supported by anecdotal observations as well, although not proven. The European product Essentiale forte N from Aventis is also commonly used for liver protection and unlike silymarin and Liv-52, has been directly studied in steroid-using bodybuilders.

“Compound N”

Essentiale forte N actually has the distinction of being the only natural supplement that has been shown in clinical studies to offset the hepatotoxic properties of oral anabolic/androgenic steroids. During this investigation, 320 healthy weight-training individuals were recruited and divided into three groups. The first group (A) consisted of 44 steroid users who were given Essentiale forte N (identified in the study as Compound N) to use with their next cycle. The second group (B) consisted of 116 subjects using anabolic steroids only. The last group (C) was 160 non-steroid using controls. All steroid users abstained from drug use for five weeks prior to the study and resumed their normal regimens, usually of multidrug programs in doses in excess of therapeutic amounts. The investigators did note the perceived risk differences between therapeutic doses and above therapeutic levels, as well as the increased hepatotoxicity of c-17 alpha-alkylated steroids and divided their groups so as to minimize these influencing factors.

The level of relative liver strain noted during the course of the study was assessed every 10 days by analyzing the blood for a full panel of liver enzymes. This specifically included aspartate aminotransferase (AST/SGOT), alanine aminotransferase (ALT/SGPT), lactate dehydrogenase (LDH), alkaline phosphatase (ALP), gamma-glutamyltransferase (GGT) and creatine kinase (CK). Baseline levels for all enzymes were similar between groups except creatine kinase, which is heavily influenced by training intensity. During the study, the steroid-only users (group B) noticed a significant elevation in liver enzymes, resulting in levels that exceeded the normal range. Liver enzymes were elevated in the remaining two groups, however, the elevations were similar and remained within the normal range at all times. The researchers were left to conclude: “The positive association of the abuse severity with the increased hepatic enzymes’ levels suggest a relationship between abused AAS and hepatic cell damage. However, when AAS were taken with …[Essentiale forte N], … the hepatotoxic effect appears to be attenuated.”

The main focus of this article was to discuss some of the basics of examining and maintaining liver health when taking hepatotoxic oral (or injectable) anabolic/androgenic steroids. For those reading who have not taken a keen interest in having their liver enzymes examined, it is my hope that this article may change your perception of this issue just a bit, perhaps enough to begin regular testing. - William L.