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CASE REPORT
1
Gastroenterology and Nutrition, Rush University Medical College, Chicago, Illinois, USA, and 2Pulmonary and Critical
Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
Abstract
While high protein diets are increasing in popularity, there is a lack of data on their potential adverse effects. We describe two
patients on high protein supplements and exercising for physical fitness. Both developed intermittent abdominal pain,
transient elevations in transaminases and hyperalbuminemia without there being any identifiable cause. The symptoms and
abnormalities on the laboratory tests resolved after the high protein intake was discontinued. While the pathogenesis and
importance of these abnormalities need further study, the findings raise concerns regarding the safety of high protein diets
combined with high intensity exercise.
For personal use only.
Key Words: Abnormal liver tests, high protein diet, hpyeralbuminemia, protein supplements
Correspondence: Ece A. Mutlu, MD, MBA, Gastroenterology and Nutrition, Rush University Medical College, 1725 W. Harrison, Suite 206, Chicago, IL
60612, USA. Tel: /1 312 5633 880. Fax: /1 312 5633 883. E-mail: Ece_Mutlu@rush.edu
Creatinine (mg/dl, N: 0.6 1.2) 0.9 0.9 protein intake can increase albumin synthesis by
Albumin (g/dl, N: 3.5 5) 5.7 4.2 about 30% [4] and increase insulin-like growth
ASAT (U/L, N: 0 40) 32 30 factor-1 levels. Elevated b-endorphins as a result of
ALAT (U/L, N: 0 48) 53 30
Hemoglobin (g/dl, N: 13 17) 14.1 14.4
vigorous exercise can potentially stimulate albumin
synthesis possibly via a direct effect on the opioid
Patient 2
receptors [5]. We speculate that hyperalbuminemia
Calorie intake (Kcal/day) 2200 2300
Protein intake (g/kg/day) 2.2 1.2 seen in our patients was likely due to the combined
Weight (kg) 77 80 effects of high-protein intake (availability of amino
BMI (kg/m2) 23.26 24.17 acids) and a high level of exercise (b-endorphins).
Pulse (beats/min) 64 58 While the pathogenesis and clinical importance of
Blood pressure (mmHg) 150/90 138/85
hyperalbuminemia and mild elevation of transami-
For personal use only.
and transaminases normalized within three months [2] Perrault J, Devroede G, Bounous G. Effects of an elemental
diet in healthy volunteers. Gastroenterology 1973;64:569 76.
of reducing protein intake to 1.2 g/kg/day. The / /
tion of a high-protein diet and normalization of [4] Kaysen GA, Gambertoglio J, Jimenez I, Jones H, Hutchison
transaminases and albumin suggests an associa- FN. Effect of dietary protein intake on albumin homeostasis
in nephrotic patients. Kidney Int 1986;29:572 7.
tion between this diet and metabolic abnorma-
/ /