Scandinavian Journal of Gastroenterology, 2006; 41: 759
760

CASE REPORT

Hyperalbuminemia and elevated transaminases associated with

high-protein diet

ECE A. MUTLU1, ALI KESHAVARZIAN1 & GÖKHAN M. MUTLU2

Scand J Gastroenterol Downloaded from informahealthcare.com by University of Newcastle on 09/07/14

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

Introduction 0
48 U/l). Serum HCO3 was 26 mEq/l and

Although there is increasing interest in high-protein
diets, the data about possible adverse effects are
scarce. Serum albumin levels increase in parallel
with increased protein intake [1,2] and dehydration
is the only known cause of hyperalbuminemia in
humans. Our recent findings in two patients suggest
that a high-protein diet may be associated with
transient elevations in transaminases leading to
hyperalbuminemia in humans.
Patient 1: A 19-year-old woman, presented with
epigastric pain for 8 months. The patient reported
no other symptoms. She did not use alcohol or
drugs. She had been on a high-protein diet
(protein bars) for over a year (protein and calorie
intake 2.1 g/kg and 1800 kcal, respectively). The
patient exercised for one to two hours every
evening. Her weight was 50 kg (body mass index
(BMI) /19.53 kg/m2). Her pulse was 45/min.
Examination was normal except for minimal epi-
gastric tenderness. Laboratory data were significant
for albumin of 5.7 g/dl, aspartate aminotransferase
(ASAT) of 32 U/l (normal 0
40 U/l) and ala-
nine aminotransferase (ALAT) of 53 U/l (normal
hemoglobin was 14.1 g/dl (Table I). Abdominal
ultrasonography, viral hepatitis serology, iron stu-
dies and autoimmune work-up were negative.
Within three weeks of decreasing her daily protein
intake to 1 g/kg, the patient’s abdominal pain
improved and both transaminases normalized at
30 U/l. Three months later, albumin was normal-
ized at 4.2 g/dl. There was no change in the
intensity or duration of exercise.
Patient 2: A 31-year-old man, presented with dull,
right upper quadrant pain for several months with no
associated symptoms. He denied any alcohol or drug
use. He was on a high-protein diet (2.2 g/kg and
2200 kcal/day) and he ran 5 miles a day, early in the
evenings. His examination was normal. Blood pres-
sure was 150/90 mmHg; pulse was 64/min. The
patient weighed 77 kg (BMI /23.26 kg/m2). La-
boratory data were significant for albumin concen-
tration sof 5.8 g/dl. ASAT and ALAT were elevated
at 67 U/l (Table I). Hemoglobin was 14.5 g/dl.
Computed tomography of the abdomen and labora-
tory work-up for elevated transaminases were nor-
mal. Abdominal pain resolved and serum albumin

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

(Received 22 March 2005; accepted 24 October 2005)

ISSN 0036-5521 print/ISSN 1502-7708 online # 2006 Taylor & Francis
DOI: 10.1080/00365520500442625
 760 E. A. Mutlu et al.
Table I. Patient characteristics and laboratory data.
patients represent the first cases of hyperalbu-
minemia associated with a condition other than
Initial Three
dehydration.
presentation months later
Laboratory and imaging studies to determine
Patient 1 causes of abnormal transaminases including viral
Calorie intake (Kcal/day) 1800 1800 serology, iron and autoimmune studies, and protein
Protein intake (g/kg/day) 2.1 1.0 electrophoresis were negative. While the exact me-
Weight (kg) 50 51
BMI (kg/m2) 19.53 19.92
chanism is not clear, the mild elevations in transa-
Pulse (beats/min) 45 51 minases observed in our patients were most likely
Blood pressure (mmHg) 100/65 103/60 due to increased synthesis of these enzymes, possibly
Sodium (mEqL, N: 135
145) 140 141 in response to increased glucagon secretion asso-
Potassium (mEqL, N: 3.5
5) 4.4 4.0 ciated with a high-protein intake [3].
Chloride (mEqL, N: 95
108) 100 102
HCO3 (mEq/L, N: 24
30) 26 25
Similarly, the mechanisms responsible for hyper-
BUN (mg/dl, N: 8
22) 16 14 albuminemia in our patients are not clear. High-
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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.

Sodium (mEq/l, N: 135
145) 140 141

Potassium (mEq/l, N: 3.5
5) 4.3 4.3 nases are not clear at this time, these findings raise
Chloride (mEq/l, N: 95
108) 102 103 concerns about the safety of high-protein diets in
HCO3 (mEq/l, N: 24
30) 26 26 combination with high-intensity exercise, which has
BUN (mg/dl, N: 8
22) 12 11 become increasingly popular especially among young
Creatinine (mg/dl, N: 0.6
1.3) 0.9 0.8
adults.
Albumin (g/dl, N: 3.5
5) 5.8 4.4
ASAT (U/l, N: 0
40) 67 24
ALAT (U/l, N: 0
48) 67 28
Hemoglobin (g/dl, N: 13
17) 14.5 14.2

Abbreviations: BMI/body mass index; BUN/blood urea nitro-

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