Explaining the Normalization and Revised Differential

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
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• Explore our full library of articles on health and performance: barbellmedicine.com/resources
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• 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/

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