By: Author L Rea

As a researcher, consultant and writer I find myself fortunate enough to be in contact with some truly wonderful people and very bright minds. On occasion these contacts bring a sense of sadness and other times merely a need for urgency. The following is a question I received from a very intelligent individual, whose words needed that possible issue of urgency.

A Loaded Question

In reality I need your opinion; being one of the very few people I can actually have an intelligent conversation with about health and pharmaceuticals.

I'm in my forties and certain adjustments have to be made for health as well as maturity issues.

I have been battling health anxiety since I've been on anabolics. Now I know I have an anxious, obsessive type of personality, but at times my suspicions were actuated where my blood works showed unfavorable results... mostly cholesterol and liver enzymes.

Needless to say, I resorted to more research to counteract the deleterious effects of the AS by ingesting 20 to 25 pills/day of all kinds of supplements, vitamins,  psyllium... bla bla bla.)

My latest results sure blew the wind out of my sails... with a twist though.

My Cholesterol is way up there (irrelevant of safeguards) as well as my Bilirubin (2.3 mg/dl) while all my other enzymes are the lowest they have been in 10 years (AST, ALT, Alk. Phos, GGT) so go figure. My doctor is stumped, I realized (according to the available medical diagnostics) that hemolysis could be at work here.

Now I'm not taking any 17-alpha alkylated compounds. All I do is Test and Deca. My only explanation is excessive erythropoesis, hence hematocrit breakdown. Could this be the cause or am I way off?

In your opinion, I want to still maintain a decent physique without indulging into a 20 year old's fantasies.

I am willing to adjust my intake of Deca (as I love that compound) as well as a bit of Testosterone to maintain a libido, without taxing my system, yet maintaining a level of acceptable anabolism going.

I'm about 195 lbs today at 5' 9", with a BF of about 6 to 7% (happy with). Have been 265 lbs in my twenties.

Now I have been on AS for most of my 25 years of lifting, what I actually need is a semblance of a recurring cycling pattern that will keep me semi-healthy as well as keep my interest in training.

In Reply

No Warning Signs Necessary

The quest for a memorable physique is a life long pursuit. Many who were in top condition in their 20's and 30's simply give up erroneously accepting that a muscular body is the domain of the young.

There are many natural and not-so-natural approaches to ones quest of perfection and neither is promised to be without potential for negative. In many cases this is due to genetic predisposition. More often it is a matter of misuse or abuse.

25 consecutive years in a row certainly is a prolonged AAS (Anabolic Androgenic Steroid) cycle to say the least. But in truth I can say that I have known of a few longer ones that had shown little in verifiable adverse side effects as well as many much shorter ones that had several reasons for concern arise.

However in the case of this individual, it is possible that he is heading for cirrhosis of the liver and likely is currently suffering from fatty liver.

For those not aware of these conditions it seems an in depth explanation is necessary. By the way, cirrhosis of the liver can be quite deadly and the stages have few warning signs.

Fatty Liver

The term 'fatty liver' refers to the build-up of fat in liver cells. Naturally fat in the liver usually is not a cause of damage by itself. But it is obviously not a normal liver condition. Under certain conditions the build-up can be a sign of harmful events taking place. Often the result is inflammation of the liver itself.

When inflammation becomes excessive scaring and hardening of the liver occurs. When scaring becomes extensive it is called cirrhosis... and that is a very serious condition.

Sadly there is a poor association between fatty liver and abnormal findings although the commonly used biochemical tests for liver disease have some value. Often a mild increase may occur in alkaline phosphatase or transaminase. Ultrasound and especially CT may reveal excess fat.

An enlarged liver as a result of inflammation can sometimes be found during a normal annual check up. This itself suggests fatty liver. However the only way to confirm this is through a liver biopsy. This is performed using a long hollow needle which is inserted into the patients liver to obtain a small tissue sample for examination under a microscope.

In reality the simple presence of excessive fat in the liver is not actually a serious problem. In fact, treatment aims at eliminating the cause or treating the underlying disorder. But, repeated liver injury from toxic substances may eventually progress from fatty liver to cirrhosis.

What Causes Fatty Liver?

I suppose that it would seem somewhat logical that eating fatty foods would be a cause of fatty liver, but this is not the case. Though the liver does play an important role in the metabolism or breakdown of fats. Something goes wrong in this process of metabolism, but it is still not known what does cause fat to build-up in the liver.

It is known that fat accumulates in the liver with a number of conditions. The most common is obesity. Fatty liver is also associated with diabetes mellitus, high blood triglycerides, and the heavy use of alcohol. It may occur with certain illnesses such as tuberculosis and malnutrition, intestinal bypass surgery for obesity, excess vitamin A in the body, or the use of certain drugs such as valproic acid.

It may also occur with the use of corticosteroids (cortisone, prednisone), estrogens and other steroids. Sometimes fatty liver can occur as a complication of pregnancy.

Known Causes: High blood triglycerides, heavy alcohol ingestion, Vitamin A toxicity, obesity, Diabetes Mellitus and several drugs have been implicated.

 

No laboratory studies can help definitively establish a diagnosis of fatty liver or NASH.

Aminotransferases

• The only abnormality may be an elevated aspartate aminotransferase (AST) or alanine aminotransferase (ALT) level. These may be elevated as much as 10-fold. However, the AST and ALT may be normal in some patients with fatty liver or NASH.

   

• In the absence of cirrhosis, an AST-to-ALT ratio of greater than 2 suggests alcohol use, whereas a ratio of less than 1 may occur in patients with NASH.

Alkaline phosphatase

• This can be elevated in some patients with NASH.

• Usually, it is less than 2- to 3-times normal.

Lipids

• Hyperlipidemia may be present.

• Increased triglycerides are common in children.

Iron studies

• Elevations in serum ferritin, iron, and/or decreased transferrin saturation may occur in patients with NASH.

• Although iron overload occurs in a small proportion of patients with NASH, these patients have more severe disease.

• Viral serological markers: Before the diagnosis of NASH can be made, viral markers should be tested and viral infection excluded.

Cirrhosis Of The Liver

Cirrhosis of the liver is a life-threatening condition. It occurs when scarring damages the liver. This scarring (also called fibrosis) replaces healthy tissue and prevents the liver from functioning, as it should. Usually years of inflammation results in cirrhosis.

Usually, as cirrhosis develops, there is an accumulation of scar tissue that surrounds healthy liver cells. This results in tissues becoming nodular or "bumpy." Commonly the next step is that the nodular liver tissue blocks the bile ducts or makes them swollen. When this occurs bile can back up in the liver and of course the blood stream.


Cirrhosis Of The Liver
Click To Enlarge.

In many cases the situation worsens when scar tissue blocks blood flow through the liver. Obstruction of blood flow can lead to a condition called portal hypertension. Portal hypertension occurs when the veins that bring blood to the liver become larger and lead to high blood pressure in the veins that flow from the intestines to the liver.

The best known causes are: Alcoholic liver disease; Chronic Hepatitis B, C, and D; Autoimmune Hepatitis; Inherited diseases; Blocked bile ducts; Nonalcoholic steatohepatitis (NASH); Drugs, toxins, and infections.

What Does A Healthy Liver Do?

The liver is the largest organ in the body. It is found high in the right upper abdomen, behind the ribs. It is a very complex organ and has over 500 functions.
• Storing energy in the form of sugar (glucose) In fact it plays a major role in maintaining normal blood sugar levels, an important source of energy for the brain, heart and muscles.

• Storing vitamins, iron, and other minerals.

• Making proteins, including blood clotting factors, to keep the body healthy and help it grow.

• Processing worn out red blood cells.

• Making bile which is needed for food digestion .

• Metabolizing or breaking down many medications and alcohol.

• Killing germs that enter the body through the intestine.

• The liver is an "incredible chemical factory," producing many important chemical compounds needed to survive, such as bile, albumin, blood clotting factors, cholesterol, Vitamin E.

• Converts amino acids (proteins) and lipids into glucose, a complex process catalyzed by a series of enzymes.

• Performs numerous other functions such as regulating lipids or metabolizing prescribed and over the counter drugs, alcohol, and many other ingested chemicals such as caffeine, etc.

• Eliminates various harmful chemicals from the body. Treats about 1,300 ml of blood per minute, thereby acting as the body's "garbage disposal."

Liver Dysfunction Takes Some Scary Forms

• Commonly prescribed cholesterol-lowering medications such as statins (Lipitor), among many other chemical drugs, are known to be toxic to the liver.

• Cirrhosis of the liver is the eighth leading cause of death in the United States - kills 25,000 people per year.

• Widely taken OTC medications are not as safe as they seem. For example, Acetaminophen (e.g. Tylenol) can be toxic to the liver and its toxicity can be accentuated by alcohol.

• The American Journal of Emergency Medicine notes that in one year, hospitals treated over 26,765 patients for alcohol toxicity and another 16,635 for Acetaminophen (Tylenol) toxicity.

• Fatigue, aches, and pain in joints and muscles, frequent headaches, stress and appetite fluctuations may be signs of an over-worked liver.

• 4,000,000 people have Hepatitis C in the United States, causing 10,000 deaths per year.