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:
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:
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.
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