There are three main types of hepatotoxicity seen clinically from the use of oral steroids. These include intrahepatic cholestasis, peliosis hepatis, and hepatic adenoma. Cholestasis is the most common side effect seen, with peliosis and adenoma being much less common. Cholestasis occurs when bile flow through the liver is impaired. When this happens, products that are normally carried in the bile to the gut and excreted begin to build up within the liver. These products can reach toxic levels and cause cell damage and death. Monitoring for liver enzymes such as AST and ALT could detect if damage was occurring in the liver. Cholesterol metabolism becomes impaired as a result of cholestasis, with an increase in LDL (Bad cholesterol) and decrease in HDL (Good cholesterol). These cholesterol changes may lead to an increased risk of heart disease, and are very common with oral steroid use. HDL below 10ng/dl is not uncommon to hear about. That’s bad considering the desired level is greater than 40ng/dl! Finally, jaundice may occur. What essentially occurs is a buildup of bilirubin, which is formed when red blood cells break down. Since it cannot be excreted in the bile, it essentially backs up into the body and causes a yellowing of skin and eyes. This is not something you want to see!
Ursodeoxycholic acid (UDCA) is a chemical called a bile acid. It occurs naturally in bile and can be used to dissolve gallstones. The liver produces bile that is stored in the gall bladder. Bile is released by the gall bladder to aid the digestion of fats. It consists of cholesterol dissolved within bile salts. Gallstones occur in the gall bladder as a result of too much cholesterol, or too few bile salts within the bile. The imbalance causes excess cholesterol to separate out of the bile and form stones. Ursodeoxycholic acid causes gallstones to dissolve by a mechanism that is not fully understood. It is known to reduce the production of cholesterol by the liver and also to reduce the absorption of cholesterol from the gut. Both of these actions decrease the amount of cholesterol that passes into the bile. Also, since ursodeoxycholic acid is a bile acid itself, it increases the level of bile acids within the bile. The combination of these two factors reverses the imbalance and stops the cholesterol separating out of the bile. The gallstones then begin to dissolve.
Besides existing in its natural form, UDCA has been synthesized, and all pharmaceutical formulations are synthetic. Besides dissolving gallstones, UDCA exerts other actions of more interest to AAS using bodybuilders. Oral 17 alpha alkylated steroids often cause a condition called cholestasis. Cholestasis is any condition in which bile excretion from the liver is blocked, which can occur either in the liver where bile is formed, or in the bile ducts.