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I would guess that most people on interferons are monitored, and taken off it if their liver is at risk.

just had a scroll thru this since it's popular, and off the top without reading the referenced articles i would say that two things stand out - yes, ms medication is damaging to the liver, even if the various enzymes don't go high enough to cause the docs alarm and a med switch, maybe chronic slight elevation is harmful enough to increase edss.

also, the healthy functionality of the liver is important to many processes that may be impacted negatively in ms.

for example, i don't know if i'm repeating anything touched on earlier this thread, but if we want to go down the d3 road, your body gets d3 cholecalciferol from sunlight or diet or supplements. the first place it goes, in order to hydroxylate into that all-important supply of 25(OH)D3 that we've all been having tested, is the liver. there are a few other tissues that effect this transformation into the second metabolite of d3, but the liver is the main one in the research i've seen to date.

a new, healthier (for whatever reason), and possibly younger liver will be more efficient at this d3 hydroxylation process, making more 25(OH) available to the kidneys (and some other tissues) for the second hydroxylation to 1,25(OH)2, the steroid hormone which provides the immune system with brakes, and damps inflammation.

this is just one potential scenario, among who knows how many...
JL

While on the subject of the liver ......... I just thought I'd add that, last year I was having a great deal of pain around the lower abdomen, so they gave me an ultra sound after my MRI revealed no lesions on the spine (that could have possibly been attributed to causing the pain ???????) they never did figure it out. But, the ultra sound did show a small amount of sclerosis in the liver ?? No explanation was given by the doctor - apparently an anomaly ? I do not drink to excess, am not on interferon's etc. etc. and, no follow up.

Dahlia--Snce you must know of my fixation on insulin and the pancreas, you will understand the reason I ask: Could your abdominal pain have been pancreatitis?

My suspicion is that doctors don't look for it and obviously won't find it if they are not looking for it. Of course, I think it was pancreatitis and eventually resolved itself. Just the musings of a nonscientist...

sclerosis in the liver? or cirrhosis? if it's from fatty liver that's reversible. don't know if the problem with the liver caused your pain, but you should be able to do something about liver issues. many use milk thistle for optimizing liver health. the wiki article on fatty liver looks pretty good; i haven't dug into the literature on this but the wiki might be a good starting point:

http://en.wikipedia.org/wiki/Fatty_liver

it was/is a small area of calcification. I am not a drinker, and have been on the Swank diet for years - I am not over weight. The pain went on for months, I lost a lot of weight - because I was throwing up all the time ........ a very nasty experience. I also suffered from terrible nerve like pain in my back at the same time .................. since then, the neurologist has decided it was probably a very small leasion on the spine, one so very small that they couldn't see it - that was probably causing the pain ...but, no answers for the spot in the liver .......

Dahlia--By the way, severe vomiting is another symptom of pancreatitis. My father-in-law (who does NOT have MS) has developed pancreatitis twice, once after surgery to remove his bladder, then again after surgery for a bowel blockage. Boy!Was he violently sick with throwing up!

Bumping this from years gone by and it's all jimmy's fault.

The recipient received a store of nutrients from her new liver; vitamin A, D, K, and b12. And her ability to produce vit D and store other nutrients probably increased. Maybe this accounts for her improvements?

I'm finally seeing the fatty liver light. In RRMS, I believe we are subject to constant aldosterone release. High aldosterone (the same as constantly released aldo?) has been show to cause fatty liver disease. As time passes, our livers become progressively worse. We can't store nutrients as well with a fatty liver.

I think when SPMS rolls around we shift to adrenal insufficiency (within normal range but still harmful) so aldosterone is no longer a problem but we are stuck with a fatty liver and all that it means...perhaps this is why Pointsnorth's b12 falls within a few days of a mega dose. He has fatty liver? It can't store the b12?

So, we reverse the fatty liver disease with diet and exercise? (and address aldo in RRMS)?? Has anyone focused on the fatty liver issue?

wait for it... "don't forget about hepatic zinc stores too, anon" note the reference above re reversible fatty liver. zinc is most definitely in that picture. zinc has been shown to reverse liver cirrhosis too.

anon let me also draw this older topic to your attention:

http://www.thisisms.com/forum/general-d ... tml#p53740

so, cheer and i made a date to talk ms and the liver. i don't know much about the liver yet, but here's a start:

the liver has many functions that are relevant to ms-ers.
i've looked at a few things w.r.t nutrition that involve the liver, such as d3 and uric acid for starters. i've been looking at zinc and the liver for a while, and the relationship between zinc and uric acid status.

i've posted quite a bit about zinc deficiency causing membrane (keyword: endothelial) permeability problems (intestinal wall, blood brain barrier, optic neuritis, veins, etc etc etc) that are familiar to your average ms patient.
cheer mentioned a case earlier today, where a liver transplant caused a major EDSS improvement in an ms case.

today i got onto the idea of zinc deficiency potentially causing damage to the liver itself, so i searched for liver enzymes and zinc deficiency on google with this interesting result:

Effect of low-zinc status and essential fatty acids deficiency on the activities of aspartate aminotransferase and alanine aminotransferase in liver and serum of albino rats
Abstract
The effects of dietary deficiencies of zinc and essential fatty acids (EFAs) or both on aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were investigated in young growing rats. Four groups of albino rats were fed diets deficient in either EFA (4% hydrogenated coconut oil) or zinc (6 ppm) or both. The control diet was adequate in EFA (4% soybean oil) and zinc (100 ppm). The feeding trial lasted eight weeks and the activities of AST and ALT were determined in the liver and serum. EFA deficiency had no significant (p > 0.05) effect on liver AST. However, zinc and the double deficiencies depressed AST activity in the organ. Deficiencies of EFA, zinc and their combination depressed ALT activity in the liver significantly (p < 0.05) with a concomitant increase recorded in the serum. The data suggested alteration in endothelial permeability of the plasma membrane and thus leakage of membrane constituents in the tissue studied. It is therefore considered that these deficient diets may affect liver tissue negatively in view of the role of these enzymes in amino acid metabolism.

what happens in amino acid metabolism? ammonia gets produced. it's the liver's job to detoxify said ammonia. ideally, it does this by converting the ammonia to uric acid. in which we know ms-ers are dramatically low.
http://users.rcn.com/jkimball.ma.ultran ... Cycle.html
the liver requires zinc to get the job done. and/or, apparently, EFA.

Several studies have shown that zinc plays a regulatory action on the activity of ornithine-transcarbamylase (OTC), a key enzyme of urea cycle.

thoughts/comments?

that's the start and the related discussion continues for four pages.

You and your zinc. :shakeshead: lol

I wonder why the liver craze dropped off the radar. Your ref last night was the first I had heard of it which is strange because it makes a lot of sense in the context of MS from start to finish.

So, aside from ZINC and mag, what would you recommend to address a fatty liver? Choline? Vitamin C? Milk thistle?

of the various nutritional elephants in the room, i would go for the big obvious zinc elephant first...

The effect of zinc depletion on the fat content and fatty acid composition of the liver and brain in forcibly fed rats
http://www.ncbi.nlm.nih.gov/pubmed/8237078
"... After 7 days the zinc-deficient animals had a fatty liver which was characterized by an increase in fat content (68%) and dry matter (23%). ... changes in liver fatty acid composition of zinc-deficient animals suggest that the fatty liver might be the result of a disturbed metabolism of linoleic acid."

according to this rat study, choline and omega 3 can help with repair and remediation...

Omega-3 fatty acids reduce hepatic steatosis and consequently attenuate ischemia-reperfusion injury following partial hepatectomy in rats.
http://www.ncbi.nlm.nih.gov/pubmed/21840275
"Fatty livers are more susceptible to IR injury and display decreased regenerative capacity. ... Until recently, weight reduction constituted the only proven therapy for patients with fatty livers.
Steatosis was induced by a 3-wk methionine/choline-deficient diet, followed by oral administration of omega-3 FAs (Omega-3) ... Omega-3 treatment significantly reduces experimental hepatic steatosis and associated pathophysiological features, resulting in significantly reduced IR injury following PHx."

oh look, more rats! dietary fats behave differently in zinc deficiency...

Dietary fat influences the effect of zinc deficiency on liver lipids and fatty acids in rats force-fed equal quantities of diet
http://www.ncbi.nlm.nih.gov/pubmed/7931700
"The zinc-deficient rats fed the coconut oil diet developed fatty livers, whereas zinc-deficient animals fed the fish oil diet did not."

to thus explore hepatic fat, how much we owe the humble rat...

i don't think it dropped off the radar.. it never got properly on. i haven't measured my liver enzymes in ages for comparison to my dx-era levels. also my doc tells me that those tests are pretty unreliable and that patients who you know must have livers like swiss cheese, the liver enzyme numbers are still coming back normal. i think that may indicate that societally we all have crappy livers just waiting for some final straw to give.

I am still in limbo-land, but I had elevated liver enzymes during my first recognizable flare. The doctor re-ran the test after the flare, and the levels were normal.

Welcome, Nairb86.
You are not alone. Many people have elevated liver enzymes with MS flares. Here's a thread from 2008 on this topic. Jimmylegs and I learned how to love our livers. http://www.thisisms.com/forum/natural-a ... ilit=liver

Here's more of the story on how my husband Jeff and I learned about his MS/liver connection:

When Jeff was diagnosed with MS, one of his strange blood results was that his liver enzymes, AST and ALT, were 10 times higher than normal. He was slightly jaundiced and his eyes were a bit yellow. It looked like he had liver disease, and his neurologist assumed he drank too much alcohol...but Jeff didn't drink. So I did some research, and learned that high liver enzymes happened in those w/MS---even before taking any drugs.

Multiple Sclerosis Linked to Abnormal Liver Test Results-

To make the link, the researchers used data from the Sylvia Lawry Centre for MS Research in Germany, the largest database of MS clinical trial information in the world. In all, medical information from 813 people with MS enrolled in various clinical trials from North America, Australia and Europe was analyzed. The study was funded by the MS Society of Canada.

Over a two-year period, there was an over three-fold increased risk of a person with MS having an elevated liver test result compared to expectations. An elevated test result indicates that liver enzymes have leaked out of their cells. This leakage into the blood stream may be an indicator of liver cell damage.

http://www.mssociety.ca/en/releases/nr_20061101.htm

Here's the abstract---this described my husband to a T

The risk of an abnormal liver test in 813 patients with multiple sclerosis or clinically isolated syndrome enrolled in placebo arms of clinical trials was greater than expected for alanine aminotransferase (ALT) (relative risk [RR] 3.7; 95% CI: 2.3 to 6.0) and aspartate aminotransferase (AST) (RR 2.2; 95% CI: 1.3 to 3.6), although not alkaline phosphatase (AP) or total bilirubin, at first presentation. Abnormal test results were associated with higher body mass index (ALT only), male gender (ALT only), and a relapsing-remitting (vs secondary-progressive) course (ALT and AST only).

http://www.neurology.org/cgi/content/abstract/67/7/1291


So, why would liver damage be linked to MS flares??? What the heck was going on? This is what began my searching for connection, and how I created the Endothelial Health program. I believed then, and still do, that Jeff's system was overwhelmed--most likely by free radicals, toxins, viruses and low levels of oxygen. So overwhelmed, that his liver could not keep up. His blood was hypercoagulated, his inflammation numbers were thru the roof, his body wasn't functioning. And he didn't have steroids or copaxone in his system yet. He needed help! I started with the liver---

Milk thistle (Silybum marianum) has been used for 2,000 years as an herbal remedy for a variety of ailments, particularly liver, kidney, and gall bladder problems. Several scientific studies suggest that substances in milk thistle (especially a flavonoid called silymarin) protect the liver from toxins, including certain drugs such as acetaminophen (Tylenol), which can cause liver damage in high doses. Silymarin has antioxidant and anti-inflammatory properties, and it may help the liver repair itself by growing new cells.

The active ingredient -- the one that protects the liver -- in milk thistle is known as silymarin, a chemical extracted from the seeds. Silymarin is actually a group of flavonoids (silibinin, silidianin, and silicristin), which are thought to help repair liver cells damaged by alcohol and other toxic substances. Silymarin also keeps new liver cells from being destroyed by these same toxins. It reduces inflammation (which is why it is often suggested for people with liver inflammation or hepatitis) and is a strong antioxidant.

(Contraindications: Milk thistle is generally regarded as safe. Side effects are usually mild and may involve stomach upset and diarrhea. Some people may get a rash from touching milk thistle plants.
Milk thistle should not be used by pregnant or breastfeeding women.
People with a history of hormone related cancers, including breast, uterine, and prostate cancer, should not take milk thistle.
Do not take milk thistle if you are allergic to ragweed, chrysanthemums, marigolds, chamomile, yarrow, or daisies.)

http://www.umm.edu/altmed/articles/milk ... 000266.htm

Within 3 months of taking milk thistle supplements, Jeff's liver enzymes were back to normal--even though he was now on Copaxone and had taken steroids and tylenol during his first flare. He remains on milk thistle today, six years later. He takes it one week out of every month, for liver detoxification. And he's not yellow anymore.
https://www.facebook.com/note.php?note_ ... 1890857211

PwMS should keep tabs on their liver enzyme levels. We need functioning livers to deal with toxins and medications. We need functioning livers to create antioxidants, like glutathione, to fight those free radicals damaging our cells.

Hope all this info helps!
cheer