FML: Heavy lifting made me look like I was in liver failure

[halifax24]

TL;DR: “Strenous exercise” (ie lifting and extreme aerobic exercise) causes elevated LFTs and CK levels on lab work that makes it look like you’re in liver failure due to the break down of muscle protein. FML, I can’t do serious workouts now for a month…

I hope this post is okay; I’m a nurse and found it super interesting from a medical perspective and wanted to share as a PSA in case this comes up for any of you ladies in the future.

I recently decided to get off my butt and get serious about my physical fitness and decided to do one of Katy Hearn’s old spring challenges coupled with StrongCurves. Last week I did a SUPER intense leg day and then, because I wanted to increase the punishment, biked a mile home from work…With a 2.5% grade hill increase…Keep in mind I went from absolutely zero physical activity to this.

Needless to say, walking the next few days proved interesting.

Anyway, I also happened the day after this workout to be scheduled for blood work as a precursor to a male contraception clinical trial looking for healthy volunteer couples. The trial seemed simple/harmless and paid good money so I figured what could go wrong? They did routine blood work, a urinalysis and a physical and said pending blood work I was good to go.

Next day (while I was stuck in bed because I literally couldn’t walk), I get a call saying that I needed to come back for another blood draw since my labs were showing abnormal; Specifically, my AST/ALT (these are tests that give an insight to liver cell injury). Normal is a little vague and depends on the laboratory equipment and general clinical picture, but most of the time AST should be something like 0-40 IU/L in females and ALT 0-30 IU/L.

Mine was 480 and 230 respectively! Yikes. If my primary care doctor had seen those, she’d flip out. These are numbers I have seen in patients with chronic cirrhosis/biliary atresia/hepatitis but I didn’t have any of those…

I went in three days later after three days of moping because I wasn’t allowed to exercise only to find out this morning that my 4 day post-exercise labs had increased even more to a whopping 780/330. They had added on what’s called a CPK level (another blood test that usually is used to narrow down specific causes of muscle protein degradation); normally this test in women should top out at around 200 conventional units(U)/L…Mine was ...wait for it…

51216!

The people leading the research study dug around medical journals and interestingly, there are a lot of reported cases of LFT/CK elevation in male lifters (you can find some posts in r/fitness as well), but not as many in females (maybe due to the fact that female powerlifting isn’t as prevalent as male? Just a guess.)

These levels will, based on some published research, peak at days 4-5 post strenuous exercise and downtrend at day 7 (which is why I have to have yet ANOTHER blood draw tomorrow).

So, that’s my story. I am super bummed/feel like a failure because I have to delay some of the heavier aspects of my workouts over the next month assuming I qualify for the trial (but hey, $$$!) If you ladies need to have a physical done or any sort of fasting lab work, in order to get the best results, probably would be more helpful to your doctor/provider if you held off on any lifting and just do light weights/cardio for a few days before the test.

Hope that was helpful/interesting!

 

[senti]

@halifax24 Got a 199 on ALT level no symptoms at all, but I when I did the blood test, I also just started to train for a 10km run from doing like no physical activities. Still gotta do ultrasound though, hopefully it's just from the excercise and not something bad... I was also slightly over weight when I did the blood test so maybe I have fatty liver too, already on the process of losing weight so I'm not worried about fatty liver too much

 

[whisper123]

@halifax24 Went through the exact same thing. Live in a rural area so my GP just went numb when he saw my numbers. He was literally mortified. I drink on occasion but often spend months without a single drop of alcohol, no family history of liver disease, never took drugs except the very occasional joint back in my youth, was not obese or anything, no risky sexual encounters... If this was something I was certain I was on my way to an early grave.

I suffer from anxiety so that obviously helped a bunch... The same GP prescribed meds for my anxiety so he knew about it too! If you're reading this, thanks a lot pal. Your reaction almost killed me faster than any potential liver disease!

Anyway:

AST: 337
ALT: 263
GGT: 29 (was okay)

I really thought I was dying. I even told my doc I literally went from an extremely sedentary lifestyle (desk job, literally no exercise was pretty chubby) to full on heavy weightlifting overnight (started 2 days before my bloodwork).

Redid the tests a month later. Everything was absolutely normal! I pointed out that I had not done a test for CK levels back when I got my first results, which would prove my theory that this was due to the abrupt change in life style. Doc wouldn't have it and said "your creatinine levels are normal so that can't be it".

I take everything I read online with a healthy dose of salt, so even though I read online that CK levels and creatinine are not the same thing, I went to a sports doc and asked if the two were the same. He explained the difference and it all made sense.

I was told to do an ultrasound regardless. But honestly Im still working up the courage to do it because my GP scared me half to death.

It's been a year. I feel absolutely great.

TL;DR: Trust your doctors folks. The plural here is the key takeaway... There's a reason there are several fields in medicine.

 

[rowantree]

@halifax24 In this midst of this with my doc. Currently on a marathon training path, have taken 1.5 weeks off now (just over 1 wk at time of blood draw) due to several issues with my right leg (hip, foot). that training has been pretty progressive since January, but I started from a relative zero.

Also hit some STUPID hard curls last Friday and couldn’t move my arms properly for 3 days (first movement of arms Tuesday — about when I had the blood drawn).

AST : 340

ALT : 129

Potassium: 5.3

CPK: 19,742

Test was 4/23, going back in for follow up tomorrow.

“Supposed” to start running again this weekend with a 21 miler… we’ll see how results go and how the doc feels about it.

UPDATE:

Hey, so we're about a week out from my initial scare.

I used to be an economic researcher, so I've done a lot of literature reviews and I decided to do one here.

If you're going through this, please read these articles and share these with your doctor... PCPs and to be honest even most sports medicine doctors probably do not know this at all, and certainly not well... it's a very niche problem and very uncommon to discover this from relatively mundane events (doesnt happen often, and you dont get blood tests often either... so extremely rare that both occur together).

1: this will be classified as Rhabdomyolysis, and most doctors will take this VERY seriously.

2: rhabdomyolysis of this sort is extremely common from strenuous exercise--you literally break down your muslces so that your body can rebuild them.

https://journals.lww.com/acsm-msse/...atine_kinase_levels_and_renal_function.3.aspx

"Conclusion: Exertional muscle damage produced by eccentric exercise in healthy individuals can cause profound CK and Mb elevations without renal impairment."

3: here is a risk scoring model that can tell you the probability of ARF (kidney failure) and death based on some pretty standard information you probably have in your test results already

https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/1733454

 

[gbredr]

@halifax24 I’m so glad someone posted this. I recently started exercising and strength training a few weeks before my blood test and major bicep workouts the day before my test. My nurse wants me to get a liver ultrasound. When looking up why my levels could be so high, it obviously said fatty liver disease but also muscle inflammation… which brought me down this rabbit hole

 

[westcoastmagazine]

@halifax24 I just started working out fairly intensely after having not worked out consistently in years. I timed it poorly, as I had a physical after my first week back at the gym. My bloodwork came back with AST and ALT levels similar to the OP. I'm hoping it's just from working out and nothing more. Scheduling a follow-up with my specialist, but my primary care doctor is concerned, so it's making me worry.

 

[hjbastida]

@halifax24 I am in same situation but not so bad. So, what am I suppose to do? Will the body becomes accustomed to the new regime or I need to stop

 

[halifax24]

@hjbastida OP here! You just have to ease into it. I pushed myself WAY too hard with that workout but I exercise almost daily and have no issue. The fact I couldn't walk was my body telling me I dun fu*ked up.

 

[gopgabe]

@halifax24 Thank you for this post. I worked out to the point my muscles were sore for multiple days 3 days before my blood work. AST/ALT levels came back very elevated, at least this could potentially be the cause for my enzymes increase.

 

[thebelieversway]

@halifax24 Male here, but similar story. I have hereditary high blood pressure and have not been managing with exercise since the beginning of the cold season. Long story short, decided to try to jumpstart my regimen by hitting the gym with my best friend and his brother-in-law who both work out regularly. I'm competitive and I have a history of fitness, so I jumped in and kept pace. I did 2 sessions with them and then the DOMS kicked in. The following day I pissed the color of Modello colored beer.

Saw my GP and got bloodwork back. 320/226 AST/ALT and 15059 CK!

 

[jenny_lynn]

@halifax24 Same happened to me. I started working out with heavy weights a week ago, had muscle stiffness in arms and legs due to squats. I went to gym for a hr weight training and immediately after that went to give labs. Got AST at 550 and ALT at 150. Did another repeat test in 6 days and both are within range. Not sure if it’s hi starting weight training or giving blood right after workout but it gave super high AST/ALT, doctor is not convinced it’s exercise and ask me to stop all protein even though my kidney function is all normal. I strongly think it’s just exercise. Good news is it’s back to normal.

 

[yahshua]

@halifax24 Same thing happened to me made my liver enzymes borderline high and my blood cells borderline too large. I took 5 months off now I feel better also I don't over train nearly as much as I used too and I cut protein consumption and salt.

 

[terry5755]

@halifax24 So I read your post yesterday and consulted with doctor friends - they said rhabdo can cause liver failure symptoms too, not only kidney failure. Rhabdomyolysis is when there is too much damage to skeletal muscle and therefore your CPK levels are dangerously high (which yours are!).

We looked at your levels, and your AST and ALT weren't nearly as worrying as your CPK, and that it is your CPK that's causing your liver inflammation and therefore elevated AST and ALT.

Very raised CPK levels indicate rhabdo - you don't have to have kidney symptoms or bad muscle aches for this to be the case.

Edit: Rhabdo also tends to get worse 3-5 days after exercise as more and more of the dead tissue is released into the bloodstream, which your results match. Seeing as you also went from no exercise to a tonne of exercise and your pain was so bad you couldn't walk indicates more than your average DOMS. You also did exercise that starved your muscles of oxygen, which again is what causes rhabdo.

Edit 2: Larger numbers of elevated LFT/CK in males are due to steroid use.

Edit 3: People who exercise intensely regularly will have ok blood results, so there's no need to stop heavy lifting before a blood test. You went from 0 to 100 which is what caused such bad muscle breakdown. I lift very heavy and do cardio and my CPK comes back around 180-210 (hovering around the higher end of the scale is normal for lifters) when I have bloods done without having to stop lifting. What I wouldn't recommend is suddenly adding a lot of intensity to your workouts.

 

[halifax24]

@terry5755 For sure, that was pretty much what I thought too. I've had DOMS before but I couldn't walk without feeling AWFUL. The docs running the research study didn't diagnose it as actual rhabdo (they thought it needed the kidney component) which I thought was interesting...This study is being run by a mix of endocrinologists though so I'm sure a clinical definition is gonna vary from doc to doc, especially since that's something more readily diagnosed and treated by general practitioners/internal medicine/hospitalists/etc rather than specialists like endocrinologists, haha.

 

[terry5755]

@halifax24 Ahh yeah that would make sense - you don't need kidney failure to have rhabdo. Rhabdo is muscle breakdown into blood, it can cause all sorts of things. It makes you feel like you've been hit by a train. Go easier on your workouts and intensify over time!

I never heard about rhabdo until 6 months ago and since then any time I've taken a break (even if it's just 2 weeks), I've been super cautious about easing myself back in.

Edit: Out of interest, are your bloods better now?