Episode #389: Your Liver Enzymes Are Elevated — But It Might Not Be Your Liver
Barbell Medicine Podcast
Barbell Medicine
4.8 • 1.3K Ratings
🗓️ 9 March 2026
⏱️ 64 minutes
🧾️ Download transcript
Summary
A fit, healthy 39-year-old was nearly sent for a liver biopsy. The cause? Was it that he went to the gym before every blood draw or because his supplement was throwing his labs off?. Dr. Jordan Feigenbaum and Dr. Austin Baraki break down the blind spot that sends thousands of healthy athletes down an expensive, potentially unnecessary diagnostic rabbit hole every year.
Timestamps:
- 00:01:09 Introducing the Case
- 00:03:44 How to Read a Liver Panel: ALT, AST, GGT, Alk Phos, Albumin Explained
- 00:10:50 What Is GGT and Why Does It Matter Clinically?
- 00:16:38 Why Exercise, Protein, and Creatine Aren't on the Differential (Yet)
- 00:17:35 The Workup: Hepatitis Panels, Abdominal Ultrasound, and More
- 00:19:42 Second Set of Labs — The Mystery Deepens
- 00:25:25 Updated Differential: What's Still on the List?
- 00:27:08 The Labs Normalize — A Critical Clue Appears
- 00:31:40 The Reveal: Exercise Was the Cause All Along
- 00:32:18 The Mechanism: How Exercise Elevates 'Liver' Enzymes
- 00:32:54 Point 1 — ALT & AST Are Not Exclusively Liver Enzymes
- 00:33:49 Point 2 — It's Unavoidable: 100% of Lifters Are Affected
- 00:36:02 Point 3 — It Takes 10–12 Days to Normalize
- 00:37:00 Point 4 — It's Mostly Harmless
- 00:38:27 56% of Physicians Miss This Diagnosis
- 00:38:48 Why Clinicians Overlook Exercise History
- 00:44:01 Point 5 — GGT as the Differentiator (And Its Limits)
- 00:46:42 Why Alkaline Phosphatase Also Rises Post-Workout
- 00:48:51 The Cost of Missing Lifestyle Context: Over- and Under-Diagnosis
- 00:53:29 What to Say to Your Doctor: 3 Patient Scripts
- 00:59:31 5 Key Takeaways
- 01:00:25 Final Advice from Dr. Baraki
Next Steps
- For evidence-based resistance training programs: barbellmedicine.com/training-programs
- For individualized training consultation: barbellmedicine.com/coaching
- Explore our full library of articles on health and performance: barbellmedicine.com/resources
- To join Barbell Medicine Plus and get ad-free listening, product discounts, exclusive content, and more: https://barbellmedicine.supercast.com/
- To consult with Drs. Baraki or Feigenbaum email us at support@barbellmedicine.com
- Barbell Medicine Vital 5 Action Plan: https://www.barbellmedicine.com/vital-5-action-plan/
Resources:
- Case: https://pubmed.ncbi.nlm.nih.gov/37025214/
- https://pubmed.ncbi.nlm.nih.gov/29059178/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC7438350/
- https://pubmed.ncbi.nlm.nih.gov/18557801/
- https://pubmed.ncbi.nlm.nih.gov/19209234/
- https://pubmed.ncbi.nlm.nih.gov/11476029/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC11165564/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC12460594/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC2291230/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC11319523/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC3936967/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC12188904/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC7969109/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC11498664/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC3104191/
Our Sponsors:
* Check out Chilipad and use my code sleep.me/BBM for a great deal: https://sleep.me
* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com
* Check out Factor and use my code factormeals.com/bbm50off for a great deal: https://www.factor75.com
* Check out Quince and use my code quince.com/bbm for a great deal: https://www.quince.com
Advertising Inquiries: https://redcircle.com/brands
Transcript
Click on a timestamp to play from that location
| 0:00.0 | You've probably noticed that we're doing more ad reads lately to keep the lights on and the microphone's powered up. But if you want to skip all of this and get straight to the science, you should check out Barbell Medicine Plus. It's our premium subscription that lets you listen to the show entirely ad-free. Beyond just skipping the ads, you also get early access to all of our new episodes and product launches, plus exclusive content that does not go out on the main feed. |
| 0:21.4 | And on top of all that, you get exclusive discounts, like 10% off all of our programs, 15% |
| 0:26.2 | off consultations, and 25% off courses and seminars, all while supporting the work we do here |
| 0:31.0 | at Barbell Medicine. My favorite part is the direct line, our monthly Ask Us Anything, |
| 0:35.3 | where you can ask Austin and I your specific questions. Trust me, it's a lot more efficient than trying to hunt us down in person or by sliding into our DMs. And it costs about the same as a cup of coffee each month. And look, I know what a good bag of beans cost these days, but really we're talking about a very reasonable investment here. Plus, the first month is only a dollar, so there's basically zero risk in trying it out. To join, head over to barbellmedicin.com slash plus and sign up today. That's barbell |
| 0:59.3 | medicine.com slash plus. We really appreciate the support. Now, let's get back to the show. |
| 1:05.0 | Before every lab draw that he remembers, he would go to the gym and work out. In a survey of physicians that were given |
| 1:13.2 | a case where a young asymptomatic man had elevated liver associated enzymes, 56% of those physicians |
| 1:20.5 | failed to list exercise-induced muscle damage in their differential, and over 60% listed |
| 1:25.4 | primary liver disease as their diagnosis. |
| 1:33.9 | Every year, thousands of healthy, active individuals are told that their liver is failing based on a routine blood panel. The clinician sees the labs, the patient sees the panic in the |
| 1:38.5 | doctor's eyes. Next few weeks are filled with expensive imaging, viral screenings, and the |
| 1:43.2 | looming threat of a biopsy. |
| 1:45.4 | In medical school, we're taught that elevated transaminases, which are more correctly |
| 1:49.0 | called liver-associated enzymes, mean liver disease. And for the fitness enthusiast, this |
| 1:53.8 | often leads to a recommendation to stop working out or worse, misdiagnosis of drug-induced |
| 1:58.6 | liver injury. What if the very thing making the patient |
| 2:01.6 | healthy is what's making their labs look pathological. Today on the Barbell Medicine |
| 2:05.6 | podcast, we're breaking down a mystery case that highlights a massive blind spot in modern |
| 2:10.1 | medicine where a completely expected lab finding is mistaken for... And help us work through |
| 2:15.7 | this problem like a pro. It's the second most handsome doctor in North America. |
| 2:19.0 | Dr. Austin Baraki, we have a little bit of a different mystery case today. |
... |
Please login to see the full transcript.
Disclaimer: The podcast and artwork embedded on this page are from Barbell Medicine, and are the property of its owner and not affiliated with or endorsed by Tapesearch.
Generated transcripts are the property of Barbell Medicine and are distributed freely under the Fair Use doctrine. Transcripts generated by Tapesearch are not guaranteed to be accurate.
Copyright © Tapesearch 2026.