Liver Disease in Athletes - A Review

Introduction

Liver disease is a common aspect of sports medicine. Athletes, especially those involved in high-intensity sports, face long hours of intense training along with intake of a special diet, usage of additional medications, and supplementation. All these can potentially lead to liver issues. Liver diseases may range from minor enzyme alterations to major drug or exercise-induced injuries. This article intends to provide an overview of liver disease in athletes, along with its causes and strategies to prevent it from occurring.

What Are the Liver Diseases Seen in Athletes?

Athletes can have a varied pattern of liver disease based on their training level and diet.

1. Enzyme Alterations: They are commonly seen in all athletes due to lifestyle changes. It is very important to monitor them to assess overall health. Changes in enzyme levels indicate some underlying liver problems. Commonly associated enzymes are:

• Creatine kinase is involved. In energy metabolism, a temporary increase seen after high-impact sports is normal. Care must be taken as elevated creatine kinase also indicates muscle damage.

• Aspartate aminotransferase and alanine aminotransferase - Amino acid metabolism involves enzymes. Persistent increased levels indicate exercise-induced injury.

• Troponin is a muscle protein involved in its contraction. When released into the bloodstream, it indicates some cardiac muscle damage.

2. Non-Alcoholic Fatty Liver Disease: It is seen as fat accumulation in the liver. It is seen in athletes because their bodies undergo many metabolic adaptations because of their intense training. Athletes also have to consume more food as they have high caloric demands. These high calories can also give rise to a fatty liver.

3. Exercise-Induced Liver Injury: Although exercise has proven beneficial effects on the whole body, extreme physical activity or intense workouts can sometimes lead to injuries, including liver dysfunction. Intense exercises can lead to oxidative stress, which produces reactive oxygen species and can damage the liver. Also, intense activity reduced the blood supply to the liver, followed by a sudden increase. This reduction-elevation in blood levels can contribute to liver injury.

4. Drug-Induced Liver Injury: Athletes consume a lot of medications and supplements to enhance their performance. Some of these substances can injure the liver considerably. Caution should be exercised while taking any medications.

Common causes of drug-induced injury include :

1. Anabolic Steroids: These medications enhance muscle growth and perform well in sports. While they do increase performance, they lead toliver toxicity. Long-term usage can lead to severe consequences such as cancer.
2. Over-the-Counter Drugs: Certain self-administered medications like painkillers (NSAIDs) and Paracetamol taken in excess can damage the liver.
3. Supplements: Certain performance-enhancing drugs like Erythropoietin and high doses of vitamin minerals may have hepatotoxic effects.
4. Viral Hepatitis: Hepatitis is spread by close contact and exposure to infectious agents. Hepatitis refers to liver inflammation primarily caused by viruses. Athletes who are involved in close contact sports with blood exposure risk, such as boxing and wrestling, stand more prone to hepatitis. Also, equipment sharing can increase the risk of exposure to hepatitis.
5. Heart-Related Liver Injury: Intense physical activity in adults leads to changes in the heart, especially because of altered blood flow and enzyme level alterations. Biomarkers associated with cardiac stress are also elevated due to this.

How to Prevent and Manage the Liver Diseases in Athletes?

Athletes need to maintain optimum health and prevent the occurrence of all diseases. Prevention of liver diseases necessitates medical screening and monitoring, education and awareness, and healthy lifestyle choices. A few preventive measures can be followed to reduce the burden of liver disease in adults :

1. Healthy Lifestyle: Consuming a balanced diet encompassing all the macro and micronutrients is to be made mandatory for athletes. A well-balanced diet containing fruits, vegetables, whole grains, etc., should be incorporated into the routine. Decreased consumption of processed food, sugars, and unhealthy fats should be encouraged.

2. Training: Athletes should be enrolled in training programs where the difficulty level gradually increases. Sudden intense workouts can contribute to liver issues.

3. Educational Programs: Athletes must be advised to attend educational classes on the effects of performance-enhancing drugs and their side effects. They must be encouraged to avoid using them.

4. Hydration: Proper fluid intake during training and gameplay encourages good liver health and overall well-being of an individual.

5. Regular Health Checkups: These play an important role in prevention, early detection, and, if present, best management of health problems. This will allow the athletes to perform well in the longer run. Monitoring the liver function using blood tests helps identify signs of fatigue and overuse and may demand rest and recovery. Also, any nutritional deficiency due to specific diets is identified early and restored. Regular health checkups sustain the athlete's health and career.

6. Vaccinations: Certain liver diseases, especially hepatitis, can be prevented in athletes with the help of vaccines. Hepatitis A and B vaccination protect against the virus and reduce the risk of getting infected by athletes who are exposed to more travel or contact sports.

7. Stress Management: Stress significantly impacts the whole body, including the liver. Athletes, with their busy schedules and intense training, are constantly under a lot of physical, mental, and emotional stress. Implementing stress management techniques helps in supporting liver health and overall well-being.

   1. Athletes must practice meditation and deep breathing daily. This helps promote concentration and increase focus.

   2. Encouraging periods of rest and recovery between play.

   3. Ensuring adequate, good-quality sleep.

   4. Athletes must be encouraged to consult professional help when necessary to relieve stress, anxiety, and competition-related pressures.

   5. Join social support networks where they can share their struggles and get encouragement.

Conclusion

To conclude, liver disease is commonly seen in athletes mainly because of their intense training and competition, fear of bad performance, and potential exposure risks. The athletes must be encouraged to care for their liver health through an educational program that advocates free regular health checks and monitoring liver function. The athletes should all also adhere to vaccination programs. They must be made aware of the risks and side effects of excess intake of supplements and performance-enhancing drugs. With all these efforts, the athletic community can create an environment where athletes thrive in sports and overall physical and mental well-being.