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

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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
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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,
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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
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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.
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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
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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
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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
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malondialdehyde levels in cirrhotic diabetic patients. J Hepatol 1997;26:871-9.

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