Episode #389: Your Liver Enzymes Are Elevated — But It Might Not Be Your Liver

Episode #389: Your Liver Enzymes Are Elevated — But It Might Not Be Your Liver

Author: Barbell Medicine March 10, 2026 Duration: 1:01:32
Barbell Medicine Podcast
HealthHealth & FitnessFitness

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


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 FIGS and use my code FIGSRX for a great deal: https://wearfigs.com
* Check out Factor: http://factormeals.com/bbm50off
* Check out Quince: https://quince.com/bbm


Advertising Inquiries: https://redcircle.com/brands

Privacy & Opt-Out: https://redcircle.com/privacy

Hosted by the team at Barbell Medicine, the Barbell Medicine Podcast delves into the complex intersection of health, fitness, and medical science. Rather than offering quick fixes, the discussions here are grounded in evidence-based practice, exploring how training, nutrition, and lifestyle intersect with long-term well-being. You’ll hear nuanced conversations that challenge common fitness myths and provide practical insights applicable to both everyday lifters and clinical populations. Episodes often feature deep dives into rehabilitation, strength programming, pain science, and metabolic health, all delivered with a focus on applying robust scientific principles to real-world scenarios. This podcast serves as a valuable resource for anyone looking to move beyond oversimplified advice and understand the “why” behind effective training and sustainable health practices. Tune in for thoughtful analysis and accessible explanations that make the latest research relevant to your own goals.
Author: Language: English Episodes: 100

Official website RSS
Barbell Medicine Podcast
Podcast Episodes
Direct Line April 2026: Stopping Ozempic and Lifting With Osteopenia [not-audio_url] [/not-audio_url]

Duration: 38:39
Stop a GLP-1 and about two thirds of the weight loss comes back within a year. Three randomized withdrawal trials (SURMOUNT-4, STEP 1 extension, STEP 4) and a new BMJ 2026 systematic review of 37 RCTs and nearly 10,000 a…
Medical Mystery: The Man Who Got Weaker When He Started Training [not-audio_url] [/not-audio_url]

Duration: 1:15:46
A 43-year-old man starts exercising and ends up in the ER with a CK over 100x the upper limit of normal. His doctor says it’s from training. We don’t think so. In this episode, Dr. Jordan Feigenbaum and Dr. Austin Baraki…
Overtraining Syndrome: Causes, Diagnosis, and What's Actually Going On [not-audio_url] [/not-audio_url]

Duration: 1:36:05
In 2022, researchers conducted the most rigorous systematic review ever performed on overtraining syndrome — looking specifically for controlled studies that documented a human transitioning from a healthy training state…
How-To Fix Your Stalled Progress (Strength Edition) [not-audio_url] [/not-audio_url]

Duration: 23:09
Lifting more weight doesn't always mean you've gotten stronger. In this foundational session, Dr. Jordan Feigenbaum and Dr. Austin Baraki introduce the Fitness-Fatigue Model to explain why "stalled" progress is often jus…

12345...10»