Natural treatments for liver disease
Natural treatments for liver disease encompass a range of herbs and supplements that may support liver health and function. Key among these are milk thistle and S-adenosylmethionine (SAMe), which have shown varying degrees of promise for conditions such as chronic hepatitis, cirrhosis, and liver toxicity. Milk thistle, particularly its active ingredient silymarin, is often cited for its protective properties, although research findings are inconsistent, with some studies showing benefits and others indicating little to no effect. SAMe has demonstrated potential in improving symptoms related to cholestasis and may be beneficial for certain liver conditions, especially in less advanced cases.
Other proposed natural treatments include a variety of herbs like artichoke leaf, turmeric, and curcumin, which have shown some protective effects in laboratory studies. However, the evidence is often preliminary and not yet conclusive for human use. Caution is advised when using natural products, as many can be harmful to the liver, especially those that contain liver-toxic contaminants or are used in excessive doses. It is recommended that individuals with liver disease consult healthcare professionals before using herbal treatments, as some supplements may exacerbate liver conditions or interact negatively with other medications.
Natural treatments for liver disease
- PRINCIPAL PROPOSED NATURAL TREATMENTS: Milk thistle, S-adenosylmethionine
- OTHER PROPOSED NATURAL TREATMENTS: Andrographis, artichoke leaf, beet leaf, betaine (trimethylglycine), choline, dandelion, inositol, lecithin, licorice, lipoic acid, liver extracts, noni, phyllanthus, Picrorhiza kurroa, schisandra, sweet potato, taurine, thymus extract, turmeric, curcumin, berberine
- HERBS AND SUPPLEMENTS TO BE USED WITH CAUTION: Beta-carotene, blue-green algae, chaparral, coltsfoot, comfrey, germander, germanium, green tea extracts, greater celandine, kava, kombucha, mistletoe, pennyroyal, pokeroot, sassafras, skullcap, spirulina, traditional Chinese herbal medicine, vitamin A, vitamin B3
DEFINITION: Treatment of diseases of the liver
Introduction
The liver is a sophisticated chemical laboratory capable of carrying out thousands of chemical transformations on which the body depends. The liver produces important chemicals from scratch, modifies others to allow the body to use them better, and neutralizes an enormous range of toxins. However, this last function of the liver, neutralizing toxins, is also the organ’s Achilles’ heel. The process of rendering toxins harmless to the body at large may bring harm to the liver itself.
Alcohol is the most common chemical responsible for toxic damage to the liver, causing fatty liver, alcoholic hepatitis, and, potentially, cirrhosis of the liver. Exposure to industrial chemicals may harm the liver. Many prescription medications may damage the liver, too, including cholesterol-lowering drugs in the statin family and high-dose niacinalso used to reduce cholesterol levels. The over-the-counter drug acetaminophen (Tylenol) is highly toxic to the liver when taken to excess. Finally, numerous natural herbs and supplements contain chemicals that may cause or accelerate harm to the liver.
Additionally, viruses may also infect the liver, causing viral hepatitis. Hepatitis C, in particular, may become chronic and gradually destroy the liver. In addition, during pregnancy, the liver may become backed up with bile, a condition called cholestasis of pregnancy.
Conventional treatment of liver disease depends on the source of the problem. People who abuse alcohol will, at the very least, avoid further liver damage by stopping alcohol use, and, in cases short of liver cirrhosis, full liver recovery may be expected. When drugs are at fault, it may be possible to switch to a different drug.
Conventional treatment of liver injury caused by chronic viral hepatitis involves sophisticated immune-regulating therapies, which have become fairly successful. In extreme cases of liver injury, a liver transplant may be necessary.
Principal Proposed Natural Treatments
This article examines the herbs and supplements that may harm the liver and that, therefore, should not be taken by people who already have liver disease.
Milk thistle. The herb milk thistle has shown promise for a variety of liver conditions, and for this reason, it is often said to have general liver-protective properties. Some evidence suggests benefits for viral hepatitisespecially chronic hepatitiscirrhosis of the liver, alcoholic hepatitis, and liver toxicity caused by industrial chemicals, mushroom poisons, and medications. These benefits are said to result from milk thistle's active ingredient, silymarin, a flavonoid composed of silibinin, silidianin, and silicristin. These substances are said to improve liver health. However, the evidence that milk thistle works remains incomplete and contradictory.
For example, a double-blind, placebo-controlled study performed in 1981 followed 106 Finnish soldiers with alcoholic liver disease for four weeks. The treated group showed a significant decrease in elevated liver enzymes and improvement in liver histologyappearance of cells under a microscopeas evaluated by biopsy in twenty-nine persons. Two similar studies provided essentially equivalent results. However, a three-month, randomized, double-blind study of 116 people showed little to no additional benefit, perhaps because most participants reduced their alcohol consumption and almost one-half stopped drinking entirely. Another study found no benefit in seventy-two persons followed for fifteen months.
Study results similarly conflict on whether milk thistle is helpful in liver cirrhosis.
In a double-blind, placebo-controlled study of 170 people with alcoholic or nonalcoholic cirrhosis, researchers found that the four-year survival rate was 58 percent in the group treated with milk thistle, compared to only 38 percent in the placebo group. This difference was statistically significant. A double-blind, placebo-controlled trial that enrolled 172 people with cirrhosis for four years also found reductions in mortality, but they just missed the conventional cutoff for statistical significance. Another study, a two-year, double-blind, placebo-controlled trial of two hundred people with alcoholic cirrhosis, found no reduction in mortality attributable to the use of milk thistle.
The majority of published and unpublished studies on milk thistle as a treatment for liver disease conclude that benefits are seen only in low-quality trials, and even in those studies, milk thistle does not show more than a slight benefit.
Milk thistle is also used in a vague condition known as minor hepatic insufficiency, or “sluggish liver.” This term is mostly used by European physicians and American naturopathic practitionersconventional physicians in the United States do not recognize this condition. Symptoms reportedly include aching under the ribs, fatigue, unhealthy skin appearance, general malaise, constipation, premenstrual syndrome, chemical sensitivities, and allergies.
S-adenosylmethionine. The body manufactures S-adenosylmethionine (SAMe) for use in converting certain chemicals to other chemicals, specifically, through the processes of transmethylation and transsulfuration. Some evidence suggests that SAMe taken as an oral supplement may have value in the treatment of various liver diseases, including chronic viral hepatitis, liver cirrhosis, jaundice of pregnancy, and liver toxicity caused by drugs or chemicals.
Perhaps the best evidence regards cholestasis, a backup of bile in the liver caused by serious liver disease. In a two-week double-blind study of 220 people with cholestasis, the use of SAMe (1,600 milligrams daily) significantly improved liver-related symptoms compared with placebo. Most participants in this study had chronic viral hepatitis.
Another large study evaluated the potential benefits of SAMe for the treatment of people with alcoholic liver cirrhosis. This two-year, double-blind, placebo-controlled study of 117 people failed to find SAMe helpful for the group as a whole. However, in a subgroup of those with less advanced disease, treatment with SAMe appeared to reduce the number of people who needed a liver transplant or who died.
Gilbert’s syndrome is an unexplained but harmless condition in which levels of bilirubin rise in the body, causing an alarming yellowing of the skin (jaundice). Weak evidence hints that SAMe may help reduce bilirubin levels in this condition.
Other Proposed Natural Treatments
One double-blind study found evidence that a beverage made from sweet potato could improve measures of liver function in people with mild hepatitis of unspecified cause. Preliminary evidence suggests that the supplement betainetrimethylglycine, not to be confused with betaine hydrochloridemay be helpful for treating fatty liver caused by alcohol and other causes, as well as protecting the liver from toxins in general.
Despite early promise, the herb phyllanthus does not appear to be helpful for viral hepatitis. Green tea has long been considered to play a protective role against liver disease. However, the evidence is unconvincing.
Numerous other herbs and supplements have shown some promise in test-tube studies for protecting the liver. These herbs and supplements include andrographis, artichoke leaf, beet leaf, choline, dandelion, inositol, lecithin, licorice, lipoic acid, liver extracts, Picrorhiza kurroa, schisandra, taurine, thymus extract, and turmeric.
In a review of the literature, curcumin, berberine, and resveratrol were found to be among the most scientifically supported herbs used in the treatment of liver disease. These herbs often need to be taken at high doses, however, because they are poorly absorbed by the body. This high dose must be balanced with the risk of toxicity from the herb.
Hundreds of other herbs and supplements could be included on this list. However, it is a long way from test-tube studies to effects in people, and none of these treatments should be regarded as having proven or even probable liver-protective properties.
Herbs and Supplements to Use 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. For this reason, it is recommended that people with liver disease not use medicinal herbs except under the supervision of a physician.
High doses of the supplements beta-carotene and vitamin A are thought to accelerate the progression of alcoholic liver disease in people who abuse alcohol. Nutritional supplementation at the standard daily requirement level should not cause a problem. All forms of vitamin B3, including niacin, niacinamide (nicotinamide), and inositol hexaniacinate, may damage the liver when taken in high doses.
A great many herbs and supplements have known or suspected liver-toxic properties, including chaparral, coltsfoot, corydalis, comfrey, germander, germanium (a mineral), greater celandine, green tea extractdespite its proposed benefitskava, kombucha, mistletoe, noni, pennyroyal, pokeroot, sassafras, and various herbs and minerals used in traditional Chinese herbal medicine.
In addition, herbs that are not toxic to the liver in themselves are sometimes adulterated with other herbs of similar appearance that are accidentally harvested in a misapprehension of their identityfor 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 toxic to the liver, 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 toxic to the liver, 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. Case reports suggest that even very high doses of valerian do not harm the liver.
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