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
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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