Nutritional
Supplements and
Herbs for Liver
Cirrhosis
Liver Cirrhosis
Liver cirrhosis is a condition of severe damage to the liver that liver is
unable to function normally. Mostly, it results from chronic alcoholism,
hepatitis B, C, D, cystic fibrosis, hemochromatosis, and Wilson’s
disease. If severe, liver cirrhosis may lead to liver failure and death. It may
also cause portal-systemic encephalopathy (PSE) to the brain, which may
lead to coma. Cirrhosis can also happen to the bile ducts- biliary cirrhosis
(PBC). It damages the bile ducts connecting the liver and gallbladder.
Signs and Symptoms of Liver Cirrhosis
Symptoms include weakness, loss of appetite, malaise, and weight loss.
However, some people with cirrhosis may not have any symptoms for years.
With blocked bile flow, jaundice, itching, and fatty yellow skin nodules are
most likely to happen. At later stage, massive bleeding inside the throat,
brain abnormalities, liver failure, and death may occur.
Treatments
Treatment is supportive, such as withdrawal of alcohol and other toxic
agents, correction of nutritional deficiencies [1-3]. Liver transplantation may
be needed for patients with advanced disease.
Adequate protein intake is essential [4] However, people with liver cirrhosis
may not be able to detoxify ammonia, a major product of protein digestion.
Ammonia toxicity leads to PSE [5]. If excess amount of copper accumulated
in the liver, foods rich in copper such as chocolate, shellfish and liver
should be avoided [7].
Nutritional Supplements AND HERBS
S-adenosylmethionine (SAMe), Branched-chain amino acids.
L-ornithine-L-aspartate, Phosphatidylcholine, bupleurum, L-carnitine,
Selenium and Vitamin E have been used as nutritional supplements for liver
cirrhosis.
Preliminary trials suggest that 180-800 mg (per day) of
S-adenosylmethionine (SAMe) may improve liver function in people with
liver cirrhosis [8,9]. SAMe supplementation is able to reverse the depletion
of glutathione and relieve cholestasis (blocked bile flow) [10-11]. High dose
of SAMe, e.g. 1200 mg per day, may improve survival and liver function in
alcoholic liver cirrhosis [12].
As discussed before, liver cirrhosis is characterized by low blood levels of
branched-chain amino acids (isoleucine, leucine, and valine) [13, 14]. This
imbalance may contribute to the development of PSE [15]. Consequently,
some people thought that branched-chain amino acids supplementation
could be a way to correct this problem [16].
Phosphatidylcholine (PC) may be able to break down liver scar tissue and
reverse tissue changes that cause cirrhosis [17-20]. But more experiments
are needed to support this argument.
Some people with liver cirrhosis have zinc deficiency [21, 22] and have
decreased secretion of bile acids [23]. Supplementation with bile salts and
zinc sulfate may be beneficial to them [24-26].
L-ornithine-L-aspartate, L-carnitine vitamin E and selenium may have
beneficial effect for cirrhosis and hepatic encephalopathy [27-35].
Herbs may help liver cirrhosis include bupleurum, peony, licorice roots and
milk thistle. Bupleurum reduces the risk of liver cancer in some people with
liver cirrhosis [36]. Combined use of white peony and licorice roots
effectively may relieve muscle cramps due to cirrhosis of the liver [37]. Milk
thistle (Silybum marianum) containing a large amount of flavonoids
(silymarin) may improve liver function and increase survival in people with
cirrhosis [38-41].
References
1. Halsted CH. Alcohol: medical and nutritional effects. In Ziegler EE, Filer LJ (eds). Present Knowledge in Nutrition,
7th ed. ILSI Press, Washington, DC, 1996, 553. 2. Roggin GM, Iber FL, Kater RM, Tabon F. Malabsorption in the
chronic alcoholic. Johns Hopkins Med J 1969;125:321-30. 3. Roggin GM, Iber FL, Linscheer WG. Intraluminal fat
digestion in the chronic alcoholic. Gut 1972;13:107-11. 4. Lochs H, Plauth M. Liver cirrhosis: rationale and
modalities for nutritional support—the European Society of Parenteral and Enteral Nutrition consensus and
beyond. Curr Opin Clin Nutr Metab Care 1999;2:345-9. 5. Lieber CS. Nutrition in liver disorders. In: Shils ME,
Olson JA, Shike M, Ross AC (eds). Modern Nutrition in Health and Disease, 9th ed. Baltimore, MD: Williams and
Wilkins, 1999, 1179-80. 7. Lieber CS. Nutrition in liver disorders. In: Shils ME, Olson JA, Shike M, Ross AC
(eds). Modern Nutrition in Health and Disease, 9th ed. Baltimore, MD: Williams and Wilkins, 1999:1179-80. 8.
Miglio F, Stefanini GF, Corazza GR, et al. Double-blind studies of the therapeutic action of S-Adenosylmethionine
(SAMe) in oral administration, in liver cirrhosis and other chronic hepatitides. Minerva Med 1975;66:1595-9 [In
Italian]. 9. Gorbakov VV, Galik VP, Kirillov SM. Experience in heptral treatment of diffuse liver diseases. Ter Arkh
1998;70:82-6 [in Russian]. 10. Loguercio C, Nardi G, Argenzio F, et al. Effect of S-adenosyl-L-methionine
administration on red blood cell cysteine and glutathione levels in alcoholic patients with and without liver disease.
Alcohol Alcohol 1994;29:597-604. 11. Frezza M, Centini G, Cammareri G, et al. S-adenosylmethionine for the
treatment of intrahepatic cholestasis of pregnancy. Results of a controlled clinical trial. Hepatogastroenterology 1990;37
Suppl 2:122-5. 12. Mato JM, Camara J, Fernandez de Paz J, et al. S-adenosylmethionine in alcoholic liver cirrhosis: a
randomized, placebo-controlled, double-blind, multicenter clinical trial. J Hepatol 1999;30:1081-9. 13. Lieber CS.
Nutrition in liver disorders. In: Shils ME, Olson JA, Shike M, Ross AC (eds). Modern Nutrition in Health and
Disease, 9th ed. Baltimore, MD: Williams and Wilkins, 1999, 1179-80. 14. Horst D, Grace ND, Conn HO, et al.
Comparison of dietary protein with an oral, branched chain-enriched amino acid supplement in chronic portal-systemic
encephalopathy: a randomized controlled trial. Hepatology 1984;4:279-87. 15. Beers MH, Berkow R (eds). The Merck
Manual, 17th ed. Whitehouse Station, NJ: Merck and Co., Inc., 1999, 362-4. 16. Okita M, Watanabe A, Nagashima
H. Treatment of liver cirrhosis with branched chain amino acid-supplemented diet. Gastroenterol Jpn 1981;16:389-92.
17. Ma X, Zhao J, Lieber CS. Polyenylphosphatidylcholine attenuates non-alcoholic hepatic fibrosis and accelerates its
regression. J Hepatol 1996;24:604-13. 18. Lieber CS, Robins SJ, Leo MA. Hepatic phosphatidylethanolamine
methyltransferase activity is decreased by ethanol and increased by phosphatidylcholine. Alcohol Clin Exp Res
1994;18:592-5. 19. Lieber CS, Robins SJ, Li J, et al. Phosphatidylcholine protects against fibrosis and cirrhosis in
the baboon. Gastroenterology 1994;106:152-9. 20. Lieber CS, DeCarli LM, Mak KM, et al. Attenuation of
alcohol-induced hepatic fibrosis by polyunsaturated lecithin. Hepatology 1990;12:1390-8. 21. Taniguchi S, Kaneto K,
Hamada T. Acquired zinc deficiency associated with alcoholic liver cirrhosis. Int J Dermatol 1995;34:651-2. 22.
Scholmerich J, Lohle E, Kottgen E, Gerok W. Zinc and vitamin A deficiency in liver cirrhosis.
Hepatogastroenterology 1983;30:119-5. 23. Vlahcevic ZR, Miller JR, Farrar JT, Swell L. Kinetics and pool size of
primary bile acids in man. Gastroenterology 1971;61:85-90. 24. Weismann K, Christensen E, Dreyer V. Zinc
supplementation in alcoholic cirrhosis. A double-blind clinical trial. Acta Med Scand 1979;205(5):361-6. 25. Larghi
A, Crosignani A, Battezzati PM, et al. Ursodeoxycholic and tauro-ursodeoxycholic acids for the treatment of primary
biliary cirrhosis: a pilot crossover study. Aliment Pharmacol Ther. 1997;11:409-14. 26. Crosignani A, Battezzati PM,
Setchell KD, et al. Tauroursodeoxycholic acid for treatment of primary biliary cirrhosis. A dose-response study. Dig
Dis Sci 1996;41:809-15. 27. Stauch S, Kircheis G, Adler G, et al. Oral L-ornithine-L-aspartate therapy of chronic
hepatic encephalopathy: results of a placebo-controlled double-blind study. J Hepatol 1998;28:856-64. 28. Kircheis G,
Nilius R, Held C, et al. Therapeutic efficacy of L-ornithine-L-aspartate infusions in patients with cirrhosis and hepatic
encephalopathy: results of a placebo-controlled, double-blind study. Hepatology 1997;25:1351-60. 29. Staedt U,
Leweling H, Gladisch R, et al. Effects of ornithine aspartate on plasma ammonia and plasma amino acids in patients
with cirrhosis. A double-blind, randomized study using a four-fold crossover design. J Hepatol 1993;19:424-30. 30.
Pugliese D, Sabba C, Ettorre G et al. Acute systemic and splanchnic haemodynamic effects of l-carnitine in patients
with cirrhosis. Drugs Exp Clin Res 1992;18:147-53. 31. Ferro D, Basili S, Practico D, et al. Vitamin E reduces
monocyte tissue factor expression in cirrhotic patients. Blood 1999;93:2945-50. 32. de la Maza MP, Petermann M,
Bunout D, Hirsch S. Effects of long-term vitamin E supplementation in alcoholic cirrhotics. J Am Coll Nutr
1995;14:192-6. 33. Burk RF, Early DS, Hill KE, et al. Plasma selenium in patients with cirrhosis. Hepatology
1998;27:794-8. 34. Feher J, Lengyel G, Blazovics A. Oxidative stress in the liver and biliary tract diseases. Scand J
Gastroenterol Suppl 1998;228:38-46. 35. Van Gossum A, Neve J. Low selenium status in alcoholic cirrhosis is
correlated with aminopyrine breath test. Preliminary effects of selenium supplementation. Biol Trace Elem Res
1995;47:201-7. 36. Yamamoto M, Oka H, Kanno T, et al. Controlled prospective trial to evaluate sho-saiko-to for the
prevention of hepatotcellular carcinoma in patients with cirrhosis of the liver. Gan To Kagaku Ryoho (Jpn J Cancer
Chemother) 1989;16:1519-24 [in Japanese]. 37. Kumada T, et al. Effect of shakuyaku-kanzo-to (Tsumura TJ-68) on
muscle cramps accompanying cirrhosis in a placebo-controlled double-blind parallel study. J Clin Ther Med
1999;15:499-523. 38. Salmi HA, Sarna S. Effect of silymarin on chemical, functional and morphological alterations of
the liver. A double-blind controlled study. Scand J Gastroenterol 1982;17:517-21. 39. Feher J, Deak G, Muzes G, et
al. Liver-protective action of silymarin therapy in chronic alcoholic liver diseases. Orv Hetil 1989;130:2723-7 [in
Hungarian]. 40. Muzes G, Deak G, Lang I, et al. Effect of silymarin (Legalon) therapy on the antioxidant defense
mechanism and lipid peroxidation in alcoholic liver disease (double blind protocol.) Orv Hetil 1990:131:863-6 [in
Hungarian]. 41. Velussi M, Cernigoi AM, De Monte A, et al. Long-term (12 months) treatment with an anti-oxidant
drug (silymarin) is effective on hyperinsulinemia, exogenous insulin need and malondialdehyde levels in cirrhotic
diabetic patients. J Hepatol 1997;26:871-9.
HOME
Supplements and
Herbs for Liver
Cirrhosis
Liver Cirrhosis
Liver cirrhosis is a condition of severe damage to the liver that liver is
unable to function normally. Mostly, it results from chronic alcoholism,
hepatitis B, C, D, cystic fibrosis, hemochromatosis, and Wilson’s
disease. If severe, liver cirrhosis may lead to liver failure and death. It may
also cause portal-systemic encephalopathy (PSE) to the brain, which may
lead to coma. Cirrhosis can also happen to the bile ducts- biliary cirrhosis
(PBC). It damages the bile ducts connecting the liver and gallbladder.
Signs and Symptoms of Liver Cirrhosis
Symptoms include weakness, loss of appetite, malaise, and weight loss.
However, some people with cirrhosis may not have any symptoms for years.
With blocked bile flow, jaundice, itching, and fatty yellow skin nodules are
most likely to happen. At later stage, massive bleeding inside the throat,
brain abnormalities, liver failure, and death may occur.
Treatments
Treatment is supportive, such as withdrawal of alcohol and other toxic
agents, correction of nutritional deficiencies [1-3]. Liver transplantation may
be needed for patients with advanced disease.
Adequate protein intake is essential [4] However, people with liver cirrhosis
may not be able to detoxify ammonia, a major product of protein digestion.
Ammonia toxicity leads to PSE [5]. If excess amount of copper accumulated
in the liver, foods rich in copper such as chocolate, shellfish and liver
should be avoided [7].
Nutritional Supplements AND HERBS
S-adenosylmethionine (SAMe), Branched-chain amino acids.
L-ornithine-L-aspartate, Phosphatidylcholine, bupleurum, L-carnitine,
Selenium and Vitamin E have been used as nutritional supplements for liver
cirrhosis.
Preliminary trials suggest that 180-800 mg (per day) of
S-adenosylmethionine (SAMe) may improve liver function in people with
liver cirrhosis [8,9]. SAMe supplementation is able to reverse the depletion
of glutathione and relieve cholestasis (blocked bile flow) [10-11]. High dose
of SAMe, e.g. 1200 mg per day, may improve survival and liver function in
alcoholic liver cirrhosis [12].
As discussed before, liver cirrhosis is characterized by low blood levels of
branched-chain amino acids (isoleucine, leucine, and valine) [13, 14]. This
imbalance may contribute to the development of PSE [15]. Consequently,
some people thought that branched-chain amino acids supplementation
could be a way to correct this problem [16].
Phosphatidylcholine (PC) may be able to break down liver scar tissue and
reverse tissue changes that cause cirrhosis [17-20]. But more experiments
are needed to support this argument.
Some people with liver cirrhosis have zinc deficiency [21, 22] and have
decreased secretion of bile acids [23]. Supplementation with bile salts and
zinc sulfate may be beneficial to them [24-26].
L-ornithine-L-aspartate, L-carnitine vitamin E and selenium may have
beneficial effect for cirrhosis and hepatic encephalopathy [27-35].
Herbs may help liver cirrhosis include bupleurum, peony, licorice roots and
milk thistle. Bupleurum reduces the risk of liver cancer in some people with
liver cirrhosis [36]. Combined use of white peony and licorice roots
effectively may relieve muscle cramps due to cirrhosis of the liver [37]. Milk
thistle (Silybum marianum) containing a large amount of flavonoids
(silymarin) may improve liver function and increase survival in people with
cirrhosis [38-41].
References
1. Halsted CH. Alcohol: medical and nutritional effects. In Ziegler EE, Filer LJ (eds). Present Knowledge in Nutrition,
7th ed. ILSI Press, Washington, DC, 1996, 553. 2. Roggin GM, Iber FL, Kater RM, Tabon F. Malabsorption in the
chronic alcoholic. Johns Hopkins Med J 1969;125:321-30. 3. Roggin GM, Iber FL, Linscheer WG. Intraluminal fat
digestion in the chronic alcoholic. Gut 1972;13:107-11. 4. Lochs H, Plauth M. Liver cirrhosis: rationale and
modalities for nutritional support—the European Society of Parenteral and Enteral Nutrition consensus and
beyond. Curr Opin Clin Nutr Metab Care 1999;2:345-9. 5. Lieber CS. Nutrition in liver disorders. In: Shils ME,
Olson JA, Shike M, Ross AC (eds). Modern Nutrition in Health and Disease, 9th ed. Baltimore, MD: Williams and
Wilkins, 1999, 1179-80. 7. Lieber CS. Nutrition in liver disorders. In: Shils ME, Olson JA, Shike M, Ross AC
(eds). Modern Nutrition in Health and Disease, 9th ed. Baltimore, MD: Williams and Wilkins, 1999:1179-80. 8.
Miglio F, Stefanini GF, Corazza GR, et al. Double-blind studies of the therapeutic action of S-Adenosylmethionine
(SAMe) in oral administration, in liver cirrhosis and other chronic hepatitides. Minerva Med 1975;66:1595-9 [In
Italian]. 9. Gorbakov VV, Galik VP, Kirillov SM. Experience in heptral treatment of diffuse liver diseases. Ter Arkh
1998;70:82-6 [in Russian]. 10. Loguercio C, Nardi G, Argenzio F, et al. Effect of S-adenosyl-L-methionine
administration on red blood cell cysteine and glutathione levels in alcoholic patients with and without liver disease.
Alcohol Alcohol 1994;29:597-604. 11. Frezza M, Centini G, Cammareri G, et al. S-adenosylmethionine for the
treatment of intrahepatic cholestasis of pregnancy. Results of a controlled clinical trial. Hepatogastroenterology 1990;37
Suppl 2:122-5. 12. Mato JM, Camara J, Fernandez de Paz J, et al. S-adenosylmethionine in alcoholic liver cirrhosis: a
randomized, placebo-controlled, double-blind, multicenter clinical trial. J Hepatol 1999;30:1081-9. 13. Lieber CS.
Nutrition in liver disorders. In: Shils ME, Olson JA, Shike M, Ross AC (eds). Modern Nutrition in Health and
Disease, 9th ed. Baltimore, MD: Williams and Wilkins, 1999, 1179-80. 14. Horst D, Grace ND, Conn HO, et al.
Comparison of dietary protein with an oral, branched chain-enriched amino acid supplement in chronic portal-systemic
encephalopathy: a randomized controlled trial. Hepatology 1984;4:279-87. 15. Beers MH, Berkow R (eds). The Merck
Manual, 17th ed. Whitehouse Station, NJ: Merck and Co., Inc., 1999, 362-4. 16. Okita M, Watanabe A, Nagashima
H. Treatment of liver cirrhosis with branched chain amino acid-supplemented diet. Gastroenterol Jpn 1981;16:389-92.
17. Ma X, Zhao J, Lieber CS. Polyenylphosphatidylcholine attenuates non-alcoholic hepatic fibrosis and accelerates its
regression. J Hepatol 1996;24:604-13. 18. Lieber CS, Robins SJ, Leo MA. Hepatic phosphatidylethanolamine
methyltransferase activity is decreased by ethanol and increased by phosphatidylcholine. Alcohol Clin Exp Res
1994;18:592-5. 19. Lieber CS, Robins SJ, Li J, et al. Phosphatidylcholine protects against fibrosis and cirrhosis in
the baboon. Gastroenterology 1994;106:152-9. 20. Lieber CS, DeCarli LM, Mak KM, et al. Attenuation of
alcohol-induced hepatic fibrosis by polyunsaturated lecithin. Hepatology 1990;12:1390-8. 21. Taniguchi S, Kaneto K,
Hamada T. Acquired zinc deficiency associated with alcoholic liver cirrhosis. Int J Dermatol 1995;34:651-2. 22.
Scholmerich J, Lohle E, Kottgen E, Gerok W. Zinc and vitamin A deficiency in liver cirrhosis.
Hepatogastroenterology 1983;30:119-5. 23. Vlahcevic ZR, Miller JR, Farrar JT, Swell L. Kinetics and pool size of
primary bile acids in man. Gastroenterology 1971;61:85-90. 24. Weismann K, Christensen E, Dreyer V. Zinc
supplementation in alcoholic cirrhosis. A double-blind clinical trial. Acta Med Scand 1979;205(5):361-6. 25. Larghi
A, Crosignani A, Battezzati PM, et al. Ursodeoxycholic and tauro-ursodeoxycholic acids for the treatment of primary
biliary cirrhosis: a pilot crossover study. Aliment Pharmacol Ther. 1997;11:409-14. 26. Crosignani A, Battezzati PM,
Setchell KD, et al. Tauroursodeoxycholic acid for treatment of primary biliary cirrhosis. A dose-response study. Dig
Dis Sci 1996;41:809-15. 27. Stauch S, Kircheis G, Adler G, et al. Oral L-ornithine-L-aspartate therapy of chronic
hepatic encephalopathy: results of a placebo-controlled double-blind study. J Hepatol 1998;28:856-64. 28. Kircheis G,
Nilius R, Held C, et al. Therapeutic efficacy of L-ornithine-L-aspartate infusions in patients with cirrhosis and hepatic
encephalopathy: results of a placebo-controlled, double-blind study. Hepatology 1997;25:1351-60. 29. Staedt U,
Leweling H, Gladisch R, et al. Effects of ornithine aspartate on plasma ammonia and plasma amino acids in patients
with cirrhosis. A double-blind, randomized study using a four-fold crossover design. J Hepatol 1993;19:424-30. 30.
Pugliese D, Sabba C, Ettorre G et al. Acute systemic and splanchnic haemodynamic effects of l-carnitine in patients
with cirrhosis. Drugs Exp Clin Res 1992;18:147-53. 31. Ferro D, Basili S, Practico D, et al. Vitamin E reduces
monocyte tissue factor expression in cirrhotic patients. Blood 1999;93:2945-50. 32. de la Maza MP, Petermann M,
Bunout D, Hirsch S. Effects of long-term vitamin E supplementation in alcoholic cirrhotics. J Am Coll Nutr
1995;14:192-6. 33. Burk RF, Early DS, Hill KE, et al. Plasma selenium in patients with cirrhosis. Hepatology
1998;27:794-8. 34. Feher J, Lengyel G, Blazovics A. Oxidative stress in the liver and biliary tract diseases. Scand J
Gastroenterol Suppl 1998;228:38-46. 35. Van Gossum A, Neve J. Low selenium status in alcoholic cirrhosis is
correlated with aminopyrine breath test. Preliminary effects of selenium supplementation. Biol Trace Elem Res
1995;47:201-7. 36. Yamamoto M, Oka H, Kanno T, et al. Controlled prospective trial to evaluate sho-saiko-to for the
prevention of hepatotcellular carcinoma in patients with cirrhosis of the liver. Gan To Kagaku Ryoho (Jpn J Cancer
Chemother) 1989;16:1519-24 [in Japanese]. 37. Kumada T, et al. Effect of shakuyaku-kanzo-to (Tsumura TJ-68) on
muscle cramps accompanying cirrhosis in a placebo-controlled double-blind parallel study. J Clin Ther Med
1999;15:499-523. 38. Salmi HA, Sarna S. Effect of silymarin on chemical, functional and morphological alterations of
the liver. A double-blind controlled study. Scand J Gastroenterol 1982;17:517-21. 39. Feher J, Deak G, Muzes G, et
al. Liver-protective action of silymarin therapy in chronic alcoholic liver diseases. Orv Hetil 1989;130:2723-7 [in
Hungarian]. 40. Muzes G, Deak G, Lang I, et al. Effect of silymarin (Legalon) therapy on the antioxidant defense
mechanism and lipid peroxidation in alcoholic liver disease (double blind protocol.) Orv Hetil 1990:131:863-6 [in
Hungarian]. 41. Velussi M, Cernigoi AM, De Monte A, et al. Long-term (12 months) treatment with an anti-oxidant
drug (silymarin) is effective on hyperinsulinemia, exogenous insulin need and malondialdehyde levels in cirrhotic
diabetic patients. J Hepatol 1997;26:871-9.
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Popular
Supplements
Acetyl-L Carnitine
Acidophilus
Bladderwrack
Bilberry
Chromium
CLA
Cod Liver Oil
Coenzyme Q
Colostrum
Dandelion
EGCG
Echinacea
Eleuthero
Ellagic Acid
Eve. Primrose Oil
Fish Oil
Flaxseed
Garlic
Ginger
Ginseng
Ginkgo Biloba
Glucosamine
Gotu Kola
Guar Gum
Hyaluronic acid
Lecithin
Lycopene
Milk Thistle
Nattokinase
Passion Flower
Probiotics
Policosanol /
Polycosanol
Pycnogenol
Reishi / Lingzhi
Resveratrol
Rhodiola
Royal Jelly
Stevia
Whey
Xylitol
Supplements
Acetyl-L Carnitine
Acidophilus
Bladderwrack
Bilberry
Chromium
CLA
Cod Liver Oil
Coenzyme Q
Colostrum
Dandelion
EGCG
Echinacea
Eleuthero
Ellagic Acid
Eve. Primrose Oil
Fish Oil
Flaxseed
Garlic
Ginger
Ginseng
Ginkgo Biloba
Glucosamine
Gotu Kola
Guar Gum
Hyaluronic acid
Lecithin
Lycopene
Milk Thistle
Nattokinase
Passion Flower
Probiotics
Policosanol /
Polycosanol
Pycnogenol
Reishi / Lingzhi
Resveratrol
Rhodiola
Royal Jelly
Stevia
Whey
Xylitol