Although Sjogren’s Syndrome is most known for its effects on our eyes and salivary glands, it can affect any part of the gastrointestinal system including the liver. Of the 4 million people affected by Sjogren’s Syndrome, up to 49% have had some sort of abnormal liver testing. In honor of October being Liver Awareness Month, let’s talk about how best to protect our liver!

What exactly does the liver do?

The liver, a football-sized organ located in the right upper part of our abdomen, is critical in our overall health. Not only does it secrete enzymes that aid in digestion but it also synthesizes critical proteins for our blood and immune system health, regulates our metabolism, and filters toxins and waste products from our blood.

How can Sjogren’s affect our liver health?

We know that having one autoimmune condition can, unfortunately, increase the risk of developing additional autoimmune conditions. Autoimmune conditions that can specifically target the liver include autoimmune hepatitis and primary biliary cirrhosis. Additionally, Sjogren’s Syndrome can cause liver damage to occur more quickly with certain infections such as hepatitis as well. Rarely, the medications used to treat Sjogren’s can be associated with liver injury.

How can you find out if you have liver problems?

Symptoms of liver damage should be addressed with your doctor and can include:

• Skin and eyes that appear yellowish (jaundice)
• Abdominal pain and swelling
• Swelling in the legs and ankles
• Itchy skin
• Dark urine color
• Pale stool color
• Chronic fatigue
• Nausea or vomiting
• Loss of appetite
• Tendency to bruise easily

​​Routine lab work that is obtained for monitoring Sjogren’s Syndrome and the medications used to treat us typically will include liver function testing. This can help detect liver injury before it becomes symptomatic.

These tests include:

Alanine transaminase (ALT). ALT is an enzyme found in the liver that helps convert proteins into energy for the liver cells. When the liver is damaged, ALT is released into the bloodstream and levels increase.

Aspartate transaminase (AST). AST is an enzyme that helps metabolize amino acids. Like ALT, AST is normally present in blood at low levels. An increase in AST levels may indicate liver damage, disease, or muscle damage.

Alkaline phosphatase (ALP). ALP is an enzyme found in the liver and bone and is important for breaking down proteins. Higher-than-normal levels of ALP may indicate liver damage or diseases, such as a blocked bile duct, or certain bone diseases.

Albumin and total protein. Albumin is one of several proteins made in the liver. Your body needs these proteins to fight infections and to perform other functions. Lower-than-normal levels of albumin and total protein may indicate liver damage or disease. FYI, it is not uncommon for Sjogren’s patients to have an elevated total protein related to high amounts of antibody proteins.

Bilirubin. Bilirubin is a substance produced during the normal breakdown of red blood cells. Bilirubin passes through the liver and is excreted in the stool. Elevated levels of bilirubin (jaundice) might indicate liver damage or disease or certain types of anemia.

Gamma-glutamyltransferase (GGT). GGT is an enzyme in the blood. Higher-than-normal levels may indicate liver or bile duct damage.

L-lactate dehydrogenase (LD). LD is an enzyme found in the liver. Elevated levels may indicate liver damage but can be elevated in many other disorders.

Prothrombin time (PT). PT is the time it takes your blood to clot. Increased PT may indicate liver damage but can also be elevated if you're taking certain blood-thinning drugs, such as warfarin.

How can we best protect our liver?

I reached out to my good friend and colleague, Dr. Andrea Johnson, a gastroenterologist, and asked her how we can best keep our livers healthy!

Here are 10 Tips to Optimizing Your Liver Function.

1. Drinking coffee... Black coffee has been shown to protect the liver from the progression of scarring (fibrosis) to failure (cirrhosis) and even prevent the development of liver cancer (hepatocellular carcinoma).
2. Or green tea! Green tea is also another great liver-boosting beverage. BUT you need to drink it and NOT take it in pill form (more on why below).
3. Protect yourself from liver-damaging infections. Hepatitis infections are viruses that target the liver including hepatitis A, B, C, and E. Hepatitis A and B can be prevented through a safe and effective vaccination series. Practicing safer sex and avoiding needle sharing are ways to minimize the risk of contracting hepatitis C and HIV.
4. Get screened too! Certain groups of people are at higher risk of having been exposed to hepatitis C. They should be screened and evaluated for the treatment of this condition. These criteria include:
   • Is pregnant
   • Is over age 18
   • Is on hemodialysis
   • Has HIV
   • Ever used injectable illegal drugs
   • Was stuck by an infected needle
   • Was born between 1945 and 1965
   • Had a blood transfusion or received an organ transplant before 1992
   • Received blood-clotting factor concentrates made before 1987
   • Has had an abnormal liver test or liver disease
5. Be cautious with your use of OTC pain medications. Acetaminophen (a.k.a. Tylenol) can be a great medication for reducing fevers and pain but using too much can be very toxic to the liver. It is recommended to avoid using more than 4 grams daily (this is the equivalent of 4 doses of extra strength formulations in 24 hours). This amount may be lower if taken in combination with drinking alcohol. NSAIDs such as ibuprofen are less toxic to the liver but can cause GI and kidney issues so care with their use also needs to be considered.
6. Speaking of alcohol… It is recommended that women consume 1 or fewer standard drinks per day to minimize liver injury and damage. This is equivalent to a 5-ounce pour of wine, 1.5 ounces of spirits, or 12 ounces of beer.
7. Skip the supplements. Herbal and dietary supplements account for 20% of liver damage in the US and this number continues to increase. Tell your doctor about all pills, herbs, and supplements you take. First, to check on the safety of each item, but also because of how they might interact with each other. 
8. Eat a diet that covers the rainbow. This will naturally increase your fiber intake and help the natural detox process but provides our body with other antioxidants that prevent liver scarring and cancer development. Which foods are the best? Blueberries, grapes, and cruciferous veggies like broccoli are all amazing for liver health.
9. Cut back on the “white” foods which include refined grains and added sugars. These add stress to the liver and can promote the development of non-alcoholic fatty liver disease. Sadly, this condition affects nearly 30% of the US population.
10. Exercise is another way to help boost liver function by preventing liver damage and reducing the release of liver-damaging chemicals in the body.