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
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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