MS and Liver Enzymes

Elevated liver enzymes are a regrettably common complication of multiple sclerosis and its treatments. A new study at the University of British Columbia (UBC) is currently enrolling volunteers to see if there's a genetic predisposition for elevated liver enzymes in people with multiple sclerosis who take disease modifying drugs (DMDs) called beta interferons: Betaseron, Rebif, or Avonex.

All of the DMDs approved to treat MS carry warnings about their potential to cause high levels of an enzyme known as alanine aminotransferase (ALT).

What Is ALT?

ALT is an enzyme that normally resides inside the liver, playing a vital role in a process called the krebs cycle, a series of chemical reactions by which food is broken down into carbon dioxide, water, and energy. In the case of liver damage, ALT can leak out into the bloodstream. Elevated ALT blood test readings act as a red flag, warning doctors of potential ongoing disease or damage to a patient’s liver.

Many things elevate a person's liver enzymes. According to the Mayo Clinic, common causes include viral infections, hepatitis, obesity, alcoholism, exposure to toxins, and certain prescription drugs.

The Epstein-Barr Virus (EBV) is also on the list of possible causes of liver damage. EBV has been linked to MS, and studies to define this relationship are currently underway.

MS Linked to Abnormal Liver Tests

In a 2006 study, researchers discovered a connection between MS and elevated liver enzymes, even among patients not taking DMDs. It's a valuable reminder for those with MS to remain vigilant about their liver test results to prevent possible liver damage in its early stages.

In an interview with the National Multiple Sclerosis Society of Canada (NMSSCa), Dr. Helen Tremlett, assistant professor at the University of British Columbia and lead researcher on the 2006 study, noted that people with MS need to be extra cautious when taking any medications that could affect their liver function.

Liver damage can be asymptomatic, especially in early stages when it is most treatable. Doctors need to order regular blood work to keep an eye on the ALT levels.

“I would recommend people with MS have their liver tested as a routine part of their care when being treated with drugs known to affect the liver," Tremlett told NMSSCa. "In addition, people need to inform their doctor immediately if there is any presentation of liver disease symptoms, such as jaundice (yellow skin or yellowing of the whites of the eye), itchy skin, and unexpected fatigue."

Tremlett is also the researcher in charge of the currently enrolling study at UBC.

How to Lower Your ALT Levels

Depending on how high your enzyme levels are, a doctor may stop your DMD treatment temporarily to see if your ALT levels return to normal. In these cases, doctors will sometimes switch the patients to other therapies or stop all their pharmaceutical treatments while their livers heal.

Making dietary changes could also be beneficial for improving the health of your liver. Reducing your consumption of fatty foods and increasing the amounts of fruits and vegetables, whole grains, and low-fat dairy products in your diet is ideal. Fiber and lean protein are also part of a liver-healthy diet.

One should avoid foods high in fat—particularly those containing animal fat—and alcohol. Obesity can also be a contributing factor for elevated liver enzymes. In addition to eating a well-balanced diet and getting at least 30 minutes of aerobic exercise per day, those who are obese would benefit from consulting their doctor about a long-term weight loss plan.

For more information about the upcoming UBC study, contact Anne Smith.

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