Natural treatments for cirrhosis

• DEFINITION: Treatment of diseases of the liver.
• PRINCIPAL PROPOSED NATURAL TREATMENTS: Milk thistle, reduced alcohol consumption
• OTHER PROPOSED NATURAL TREATMENTS: Antioxidants, Ayurvedic herbal combinations, branched-chain amino acids, calcium and vitamin D, oligomeric proanthocyanidins, ornithine alpha-ketoglutarate, phosphatidylcholine, S-adenosylmethionine, taurine
• HERBS AND SUPPLEMENTS TO USE ONLY WITH CAUTION: Barberry, beta-carotene, blue-green algae, borage, carnitine, chaparral, coltsfoot, comfrey, germander, germanium, greater celandine, kava, kombucha, mistletoe, pennyroyal, pokeroot, sassafras, skullcap, spirulina, traditional Chinese herbal medicine, vitamin A, vitamin B₃, vitamin K

Introduction

The liver is a sophisticated chemical laboratory capable of carrying out thousands of chemical transformations on which the body depends. The liver produces vital chemicals from scratch, modifies others to allow the body to use them better, and neutralizes an enormous range of toxins.

A number of influences can severely damage the liver. Alcoholism is the most common. Alcohol is a powerful liver toxin that harms the liver in three stages: alcoholic fatty liver, alcoholic hepatitis, and alcoholic cirrhosis. Although the first two stages of injury are usually reversible, alcoholic cirrhosis is not. Generally, more than ten years of heavy alcohol abuse is required to cause liver cirrhosis. Other causes include hepatitis C infection, primary biliary cirrhosis, and liver damage caused by occupational chemicals and drugs.

A cirrhotic liver is firm and nodular to the touch and, in advanced cases, is shrunken in size. These changes reflect severe damage to its structure. A high percentage of liver cells have died, and fibrous scarlike tissue permeates the organ.

A cirrhotic liver cannot perform its chemical tasks, leading to wide-ranging impairment of bodily functions, such as the development of jaundice (yellowing of the skin from unprocessed toxins), mental confusion, emaciation, and skin changes. In addition, the fibrous tissue impedes blood that is supposed to pass through the liver. This leads to abdominal swelling as fluid backs up (ascites) and to bleeding in the esophagus as veins expand to provide an alternative fluid path. Ultimately, coma develops, often triggered by internal bleeding or infection.

Treatments for liver cirrhosis begin with stopping the use of alcohol and all other liver-toxic substances. A number of treatments, such as potassium-sparing diuretics, can ameliorate symptoms to some extent, but they do not cure the disease.

The liver is too complex for a machine to duplicate its functions, so there is no equivalent of kidney dialysis for liver cirrhosis. Only a liver transplant can help, but a liver transplant is a difficult operation with a high failure rate. In addition, the supply of usable livers is inadequate to meet the need.

Persons with cirrhosis of the liver should not take any medications, herbs, or dietary supplements without first consulting a physician. The liver processes many substances taken into the body, and if it is severely damaged, as during liver cirrhosis, ordinarily benign substances may become toxic.

Principal Proposed Natural Treatments

The herb milk thistle (Silybum marianum) might offer various liver-protective benefits. Milk thistle contains the antioxidant and an anti-inflammatory chemical called silymarin, which is a combination of the flavonoids silibinin, silidianin, and silicristin. These substances are said to aid in the recovery and protection of the liver. In Europe, it is used to treat viral hepatitis, alcoholic fatty liver, alcoholic hepatitis, liver cirrhosis, and drug- or chemical-induced liver toxicity. An intravenous preparation made from milk thistle is used as an antidote for poisoning by the liver-toxic death cap mushroom (Amanita phalloides). However, the supporting evidence for the use of milk thistle in any of these conditions remains far from definitive.

A double-blind, placebo-controlled study of 170 persons with alcoholic or nonalcoholic cirrhosis found that in the group treated with milk thistle, the four-year survival rate was 58 percent, while the placebo group’s rate was 38 percent, a statistically significant difference.

A double-blind, placebo-controlled trial that enrolled 172 persons with cirrhosis for four years also found reductions in mortality, but the researchers just missed the conventional cutoff for statistical significance. A two-year, double-blind, placebo-controlled study of two hundred persons with alcoholic cirrhosis found no reduction in mortality attributable to the use of milk thistle. Other double-blind studies of cirrhotic persons have found improvements in tests of liver function, although one did not.

Several reviews of studies through the first quarter of the twenty-first century indicated milk thistle's beneficial use for some individuals with cirrhosis but not others. A 2007 review of published and unpublished studies on milk thistle as a treatment for liver disease concluded that benefits were seen only in low-quality trials, and even in those, milk thistle did not show more than a slight benefit. However, in a 2008 analysis of nineteen randomized trials, researchers concluded that milk thistle was significantly more effective at reducing mortality from liver cirrhosis (mostly alcohol-related) compared with placebo but no more effective at reducing mortality from any cause. A 2018 review of over thirty studies found mostly positive impacts from milk thistle use. However, most of these studies were small observational studies. In one randomized study of ninety-nine individuals, 700 mg of milk thistle three times daily for forty-eight weeks provided significant benefits, including improved liver function, reduced fibrosis, and decreased liver stiffness.

Milk thistle is commonly used as a natural treatment for liver cirrhosis, but individuals taking medications for diabetes, raloxifene (Evista) for osteoporosis, the hepatitis C medication simeprevir, or the immunosuppressant sirolimus (Rapamune) should not use milk thistle. Additionally, some research indicates that milk thistle may impact hormones, so individuals with a history of breast, uterine, or ovarian cancer, as well as those with endometriosis or uterine fibroids, should avoid milk thistle.

Other Proposed Natural Treatments

Persons with liver cirrhosis have difficulty synthesizing the substance S-adenosylmethionine (SAMe) from the amino acid methionine. For this reason, supplemental SAMe (best known as a treatment for depression and osteoarthritis) has been tried as a treatment for cirrhosis. However, no strong evidence exists for its effectiveness.

A two-year, double-blind, placebo-controlled trial followed 117 people with alcoholic liver cirrhosis. Overall, those given SAMe did not do significantly better than those given placebo. However, when the results were reevaluated to eliminate persons with severe liver cirrhosis, a significant reduction in mortality and liver transplantation was seen with SAMe. SAMe has also shown some promise for primary biliary cirrhosis, though the evidence is not consistent.

Branched-chain amino acids (BCAAs) are naturally occurring molecules (leucine, isoleucine, and valine) that the body uses to build proteins. Because of how they are metabolized, BCAAs might be helpful for persons with liver cirrhosis. However, the evidence that BCAAs actually help is not conclusive. Furthermore, persons with cirrhosis of the liver should not increase amino acid or protein intake except under physician supervision.

Persons with cirrhosis are susceptible to internal bleeding. Preliminary evidence suggests that oligomeric proanthocyanidins (OPCs) might help prevent this problem. OPCs are best documented as a treatment for venous insufficiency (closely related to varicose veins), which is thought to work in part by stabilizing blood vessels. Persons with cirrhosis have what amounts to internal varicose veins, caused by the shunting of fluid around the damaged liver.

Other Natural Treatments

One small study suggests that the supplement carnitine might be helpful for people with hepatic encephalopathy, a life-threatening brain abnormality associated with severe cirrhosis. The amino acid taurine might help reduce muscle cramps in persons with cirrhosis.

One study suggests that protein from vegetable sources might be preferable to protein from animal sources for people with liver cirrhosis, presumably because of differences in amino acid content. Branched-chain amino acids have shown positive impacts in several studies for patients with cirrhosis. These amino acids limit hepatocellular carcinoma's growth, improving patient prognosis.

Preliminary evidence from animal studies suggests that the supplement phosphatidylcholine might help prevent alcoholic liver cirrhosis. The supplement ornithine alpha-ketoglutarate and the related substance ornithine-l-aspartate have shown promise for treating hepatic encephalopathy. Vitamin K has shown some promise in helping prevent liver cancer in people with cirrhosis of the liver. An Ayurvedic herbal combination has been studied for the treatment of cirrhosis, but evidence supporting its use remains incomplete and contradictory. A nutrient called betaine, which reduces homocysteine levels, may also be helpful. Two herbal remedies, bupleurum and licorice root, have also shown efficacy in treating cirrhosis, the former for its anti-inflammatory properties and the latter for its ability to prevent cirrhosis in patients with hepatitis C. Finally, there is a multitude of suggested homeopathic remedies for cirrhosis.

Antioxidants have been proposed for the treatment of primary biliary cirrhosis based on the theory that free radicals play a role in the disease process. However, despite apparent promise seen in open trials, a double-blind, placebo-controlled study of sixty-one persons failed to find that a combination of vitamins A, C, and E, selenium, methionine, and CoQ₁₀ produced any benefit in terms of fatigue or other liver-related symptoms.

The bones of persons with biliary cirrhosis often become thin. Taking calcium and vitamin D supplements might help. Antioxidants such as vitamin C, vitamin E, and lipoic acid, as well as functional foods like turmeric, ginger, and garlic, have been tried for biliary cirrhosis, with promising results in some preliminary trials.

In an indirect approach, apple cider vinegar may improve liver health in individuals with cirrhosis. One study found that increasing one’s intake of apple cider vinegar lowered cholesterol and fasting glucose levels, which likely improves fatty liver disease.

Choosing a healthy lifestyle is integral to the treatment of cirrhosis. Clinical studies have shown losing weight, choosing a diet high in fruits, vegetables, and whole grains, drinking coffee, exercising, and avoiding sugar are effective ways to treat cirrhosis.

Herbs and Supplements to Use Only with Caution

Many natural products have the capacity to harm the liver. Furthermore, because of the generally inadequate regulation of dietary supplements, there are real risks that herbal products may contain liver-toxic contaminants even if the actual herbs listed on the label are safe. It is recommended that persons with liver disease not use medicinal herbs except under the supervision of a physician. Listed here is specific information to aid in the decision-making process.

Vitamin A and beta-carotene supplements might cause alcoholic liver disease to develop more rapidly. All forms of vitamin B₃ may damage the liver when taken in high doses, including niacin, niacinamide (nicotinamide), and inositol hexaniacinate. Nutritional supplementation at the standard daily requirement level should not cause a problem.

A great many herbs and supplements have known or suspected liver-toxic properties, including barberry, borage, chaparral, coltsfoot, comfrey, germander, germanium (a mineral), greater celandine, certain green tea extracts, kava, kombucha, mistletoe, pennyroyal, pokeroot, sassafras, and various herbs and minerals used in traditional Chinese herbal medicine.

In addition, herbs that are not liver-toxic in themselves are sometimes adulterated with other herbs of similar appearance that are accidentally harvested in a misapprehension of their identity (for example, germander found in skullcap products). Furthermore, blue-green algae species such as spirulina may at times be contaminated with liver-toxic substances called microcystins, for which no highest safe level is known. Some articles claim that the herb echinacea is potentially liver-toxic, but this concern appears to have been based on a misunderstanding of its constituents. Echinacea contains substances in the pyrrolizidine alkaloid family. However, while many pyrrolizidine alkaloids are liver-toxic, those found in echinacea are not believed to have that property.

Whole valerian contains liver-toxic substances called valepotriates; however, valepotriates are thought to be absent from most commercial valerian products, and case reports suggest that even very high doses of valerian do not harm the liver.

Bibliography

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