Liver problems in bodybuilders-the carnage is not inevitable!

By Kim Crawford, M.D. Last updated: September 6, 2018

Liver issues for bodybuilders:

really needs foods that speed up metabolismLiver problems are not experienced only by bodybuilders. The topics I will talk about apply to those with fatty liver from lipid or obesity problems. They also apply to those who are active alcoholics.

And they apply to those with certain types of hepatitis. And the topics also apply to supplement-takers who do not buy pharmaceutical grade supplements. I’m talking about bargain shoppers who imperil their health to buy cheap supplements.

But I’m dedicating this topic to bodybuilders because in their community, they often-quite often, risk health for lean body mass gains.

And few doctors have their confidence so there have been many awful “liver stories” and not enough education for this community where information is exchanged on forums which normally don’t contain doctors-if they did, the doctors would rarely be listened to.

So, with that said, let’s get started and let me tell everyone,really what’s the problem here and how to avoid or mitigate it.

And my attention will now turn to the bodybuilding community but again, keep in mind that what I will discuss will apply to you others, OK?

What about crappy supplements causing liver issues?

Contamination and inadequte product quality standards continue to raise questions about whether supplements can be used safely. Why? Because the damage, when it occurs, can be totally catastrophic.

No matter how you feel about your supplements,we can agree that no one should lose an organ from taking a supplement. But it can happen. Supplements without a GMP sticker for quality and purity likely have toxic chemical ingredients which then have to be processed by the body.

Millions of years of evolution have given our livers the capacity to metabolize and detoxify close to everything we eat. But sometimes we’ll hand our liver something it just can’t deal with.

And sometimes those products cause real serious harm, in the form of liver failure. It is generally an unlabelled contaminant that causes the harm. Again, consumers need to make sure they are not cheaping out with supplements or they are putting themselves at risk.

Rates of hospitalization, and numbers of deaths and liver transplants are statistics which have been amassed.

Analysis divides the cases into two groups: those with injuries attributed to bodybuilding supplements, and those from other supplements.

Taking a good hard look at the statistics, one of the best ways to avoid liver damage from supplements seems to be to avoid anything related to bodybuilding, as they are the most common cause of supplement-induced liver damage.


Here are the numbers:

Between 2004 and 2013 there were 839 cases of liver injury eligible for consideration for liver transplant. 709 were from drugs, and 130 from supplements. In the pool of 130 injuries linked to supplements, 45 (35%) were from bodybuilding supplements and 85 (65%) were from all other supplement types combined.

What about anabolics?

All anabolic steroids are manipulated versions of three steroid hormones: testosterone, progesterone which is used to make nandrolone which is then used to make most of the rest of the progesterone-derived AAS and dihydrotestosterone, or  DHT. All have their advantages and disadvantages to a bodybuilder.

One advantage of testosterone injections is the absence of effect on high-density lipoprotein, a protective or “good” cholesterol.

The other steroids, especially the oral versions, are “famous” for acutely lowering HDL, thus putting “takers” at higher cardiac risk.

Some anabolic steroids are considerably more dangerous than others.

Injectable drugs, which bypass the liver are thought to be safer than oral drugs. Nandrolone has a reputation as a “gentle” anabolic steroid most suitable for those concerned about avoiding androgenic-related side effects like acne and male-pattern baldness.

Nandrolone is probably the worst steroid to use if you’re getting drug-tested events, as it can be detected in the body for more than a year after discontinuation. (People-I’m not telling anyone anything they don’t know!) The DHT-based anabolics are popular and are often considered highly anabolic because they don’t convert into estrogen.

Because oral doses of testosterone aren’t of much use, scientists tweaked the structure to prevent its destruction in the liver. The most common tweak involved C-17 alpha alkylation.

  • This was done to  prevent the liver from rapidly degrading the drug.
  • The flip (and down) side, however, was that these drugs tended to accumulate in the liver and cause hepatitis, a general term indicating  liver inflammation.
  • And this is exactly what happens with large doses of oral anabolic steroids.

Because of the way bodybuilding has “gone”, without using drugs, even the most genetically gifted bodybuilder wouldn’t stand a chance against a less “gifted” but more “juiced” competitor. The athletes repeatedly say that the health risks they’re taking  are worth the rewards.

There are four types of hepatotoxicity seen clinically from the use of oral steroids.

These include intrahepatic cholestasis, peliosis hepatis, (rare)  liver cell necrosis (also rare), and hepatic adenoma. It is intrahepatic cholestasis caused by drugs (e.g. the oral 17 alpha alkylated anabolic steroids) that is of greatest concern to bodybuilders.

Oral steroids seem to interfere with the pump that transports  bile out of liver cells. Cholestasis is by far and away the most common side effect seen, with this being what you see in “fatty liver” and early alcoholic liver disease.

Cholestasis occurs when bile flow through the liver is impaired. When this happens, products that are normally carried in the bile to the GI tract and then excreted as waste start to build up within the liver. These products can ultimately reach toxic levels to cause cellular damage and death.

And how common is this???

  • Oral 17 alpha alkylated steroids very often-almost always- cause cholestasis.
  • Cholestasis is any condition where  bile excretion from the liver is blocked.
  • It can occur either in the liver where bile is formed, or in the bile ducts.
  • Rarely, these oral muscle enhancers can cause what is called hepatocelluar necrosis or actual death of liver cells.
  • This can be quite dangerous and lead to rapid liver failure or cirrhosis.

UH Ohh Signs and Symptoms:

The first sign of trouble is elevation of liver- enzymes called ALT and AST but intense exercise can elevate these so back-up of bile with a bilirubin going up is usually the most reliable indicator, although I would argue that a doubling of ALT/AST values means lay off the orals.

l-carnitine bodybuilding doesn't cause this unless you add oral steroidsMany bodybuilders see jaundice as there first warning sign.What essentially occurs is a buildup of bilirubin. Bilirubin is formed when red blood cells break down.

Since it can’t be excreted in the bile, it basically backs up into the body and causes a yellowing of skin and eyes.

STOP the ORALS and all anabolics if you see this, are itchy, etc.

Ursodeoxycholic acid is being used experimentally in all types of cholestatic disease. I know it’s also for sale on the internet but scientists haven’t even figured out the proper dosage. If you get to this stage of the game do NOT attempt to treat this yourself please.

How to mitigate hepatic damage:

So,let me say that I do not think taking anabolics is a good idea. Will they kill you if you take them for a couple of weeks here and there? No.

But will they somehow “get you” if you take them long-term? Most definitely and I’m not just talking liver. I’m talking kidneys, heart problems, lipid issues, blood clots, high blood pressure and early death for young athletes who are being pressured to have bigger and bigger gains.

I keep telling bodybuilders who ask to substitute IGF1LR3 which preserves motor neurons to essentially make or at least SAVE muscle cells and really amp it up with bcaa/glutamine powder mixes.

Suggested liver protection:

Several natural herbs have been shown to help prevent alcohol- or drug-induced hepatic damage, one of which is the herb silymarin, or milk thistle.

Other suggested liver-protecting nutrients include gamma linoleic acid, as found in evening primrose oil or borage oil supplements.

Anything that increases glutathione, the primary liver antioxidant, and the #1 of the vitamins that give you energy (a great side effect-no?) would also help protect the liver. Supplements that raise liver glutathione include silymarin, N-acetyl cysteine (NAC) and alpha  lipoic acid—plus whey protein because of its rich cysteine content.

Reishi and cordycepts mushroom, Chinese skullcap extract, Burdock extract, and Schisandra Extract have all been studied and shown to be hepato-protective, especially when combined with Milk Thistle and  NAC. Here is a great all-around liver cleanse and protectant. 


  1. Unreal. Am on “everything” and liver is testing clean.

  2. Am a near pro bodybuilder and am on cycle and trying the hepatoben for the first time and for the first time I tested clean. I also gave this to my dad who quite frankly drinks too much and HIS liver just tested clean too.

  3. I’ve been browsing online more than 4 hours today, yet I never found any interesting
    article like yours. It is pretty worth enough for me.

    In my view, if all webmasters and bloggers made good content
    as you did, the internet will be much more useful than ever before.

FREE email consultation with Dr. Kim included with every purchase & FREE shipping on all orders over $150