Liver disease supplements and natural treatments, alternative treatment
September 16 2014 by
Ray Sahelian, M.D.

Weighing about 2-3 pounds, the liver is a vital organ located in the upper right-hand side of the abdomen. It performs numerous functions for the body: converting nutrients derived from food into essential blood components, storing vitamins and minerals, regulating blood clotting, producing proteins and enzymes, maintaining hormone balances, and metabolizing and detoxifying substances that would otherwise be harmful to the body. The liver also makes factors that help the human immune system fight infection, removes bacteria from the blood, and makes bile, which is essential for digestion.

Natural supplements for liver health
There are many substances, herbs and supplements that could be helpful in protecting liver tissue from damage. One well known substance is silymarin, a derivative from the milk thistle plant that has been used for centuries to treat liver ailments. Research results of some small studies suggest silymarin protects cells and has anti-inflammatory and regenerative properties. Acetylcysteine is another nutrient that could help liver tissue particularly in those who take acetaminophen. There are other supplements that can be of benefit, such as SAM-e and alpha lipoic acid, but long term research is not yet available to know which to take and in what dosages and combinations.

The protective effects of Phyllanthus emblica Amla extract on ethanol induced rat hepatic injury.
J Ethnopharmacol. 2006.
This study was undertaken to investigate the protective effects of
amla extract on ethanol induced rat liver injury. Amla (0.5 and 1 mg/ml) increased cell viability of rat primary cultured liver cells being treated with ethanol. Liver toxicity markers studied in rats included serum transaminases (AST and ALT), serum triglyceride (STG), hepatic triglyceride (HTG), TNF-alpha and IL-1beta together with histopathological examination. Pretreatment of rats with amla at oral dose of 25, 50 and 75 mg/kg or SL (silymarin, a reference liver protecitve agent), 4 h before ethanol, lowered the ethanol induced levels of AST, ALT and IL-1beta. Histopathological studies confirmed the beneficial roles of amla and silymarin against ethanol induced liver injury in rats.

I am interested in a supplement to support the liver. I am in good health and I'm concerned about adding a bit of support for when I am drinking wine, taking OTC pain killers, sleeping pills or having too much red meat (protein) since those types of foods overwork the liver.
   Milk thistle and acetycysteine are good options that you can discuss with your health care provider.

Dietary pills that can cause liver injury include:
Many of the products implicated in liver injuries are bodybuilding supplements spiked with unlisted steroids (which often are not listed on the labels), and herbal pills and powders promising to increase energy and help consumers lose weight. Kava herb is another one that has been implicated in such harm. Popular products like vitamins, minerals, probiotics and fish oil had not been linked to hepatic harm.

Liver disease
This can manifest itself in many different ways. Manifestations of liver disease that are particularly important include jaundice (a yellowish discoloration of the skin and the whites of the eyes), cholestasis (reduction or stoppage of bile flow), liver enlargement, portal hypertension (abnormally high blood pressure in the veins that bring blood from the intestines to the liver), ascites (accumulation of fluid in the abdominal cavity), liver (hepatic) encephalopathy (a liver disorder in which toxins build up in the blood, leading to brain dysfunction), and liver failure.

Liver disease diagnosis
Liver function tests for elevated liver enzymes is the most important first step to be done. Additional tests to determine liver disease include: Antinuclear antibodies, smooth muscle antibodies, antibodies to liver/kidney microsome type 1, antimitochondrial antibodies, and perinuclear antineutrophil cytoplasmic antibodies constitute the standard serological repertoire that should be assessed in all liver diseases of undetermined cause.

Elevated Liver enzymes
Common causes of elevated liver enzymes include: Medications, such as certain nonsteroidal anti-inflammatory drugs, acetaminophen, cholesterol-lowering medications, antibiotics and anti-seizure medications; drinking too much alcohol; obesity; diabetes; infection, such as viral hepatitis and mononucleosis; autoimmune disorders of the liver and bile ducts, such as autoimmune hepatitis and primary sclerosing cholangitis and primary biliary cirrhosis; metabolic liver disease, such as hemochromatosis and Wilson's disease; excessive use of vitamin supplements and certain herbal supplements; tumors of the liver or bile ducts.

Q. Interested to find and read your Q & A on people’s concerns re abnormal Liver Function Tests. There is however an omission in your discussion of possible causes of abnormal results excluding alcohol and that is high levels of stored iron due to Genetic Haemochromatosis (GH), Best Regards, Trustee – The Haemochromatosis Society (UK) Howard Don.

Elevated liver enzymes in children
Isolated elevation of liver enzymes in most children is generally benign and need not be a cause for immediate action or concern. Findings of prolonged abnormal liver enzymes are not rare in infants and young children. As long as these abnormal enzymes are isolated and do not involve jaundice, for example, these infants and children can be followed conservatively and there is no need for liver biopsy in most cases.

Liver function tests
A typical Liver Function Test measures several levels of enzymes and other factors. Several laboratory assays are commonly called liver function tests (LFTs), although these tests are neither specific to the liver nor true measures of liver function. As a result, alanine aminotransferase (ALT or SGPT), aspartate aminotransferase (AST or SGOT), gamma-glutamyltransferase (GGT), alkaline phosphatase (ALP) and bilirubin have proven problematic for clinicians. These include:

AP (Alkaline Phosphatase) U/L (30 to 120)
GGT (Gamma-glutamyl transpeptidase) U/L (5 to 35)
LD Lactate Dehydrogenase U/L (100-225) is an enzyme found in many body tissues, especially the heart, liver, kidney, skeletal muscle, brain, blood cells, and lungs. LDH catalyzes the interconversion of pyruvate and lactate. Exercising muscles convert (and red blood cells metabolize) glucose to lactate. Lactate is released into the blood and is eventually taken up by the liver. The liver converts lactate back to glucose and releases glucose into the blood. This glucose is then taken up by resting muscles, red blood cells, and other tissues.
AST (Aspartate aminotransferase) U/L (5 to 45)
ALT (Alanine aminotransferase) U/L (5 to 45)
Albumin g/L (38-55)
Clotting Studies (Prothrombin Time) Seconds (11 to 13.5)
Total Bilirubin - Normal range is 3 - 18 umol/L (0.174 - 1.04mg/dL).

Enlarged liver
Hepatomegaly is the medical term for enlargement of the liver. It's not a disease but a sign of an underlying problem. Many conditions can cause hepatomegaly and impair the function of the liver, including: congestive heart failure, fatty liver due to alcohol abuse, liver cancer, hepatitis, blood disorders such as leukemia, excessive iron in the body (hemochromatosis)

Fatty liver condition
Fatty liver disease can range from fatty liver alone (steatosis) to fatty liver associated with inflammation (steatohepatitis). This condition can occur with the use of alcohol (alcohol-related fatty liver) or in the absence of alcohol (nonalcoholic fatty liver disease).

Nonalcoholic fatty liver disease NASH is an increasingly recognized health problem. Increased fat accumulation in the liver is observed in 20-30% of the population in the Western world, and in approximately 10% of this cohort it is associated with nonalcoholic steatohepatitis, which is characterized by inflammation and fibrosis. Disease presentation of nonalcoholic fatty liver disease ranges from asymptomatic disease to cirrhosis with the complication of liver failure and hepatocellular carcinoma. Nonalcoholic fatty liver disease is suspected on the basis of various clinical aspects (an elevated alanine aminotransferase concentration, presence of obesity and diabetes) that alone are not sufficient to establish diagnosis or prognosis. The major diagnostic procedure is liver biopsy, which allows assessment of liver injury. In most cases, Nonalcoholic fatty liver disease is associated with insulin resistance, which is therefore the target of most current Nonalcoholic fatty liver disease treatment modalities. Various treatment strategies such as weight loss and/or exercise, thiazolidinediones, metformin, lipid-lowering agents and antioxidants have been studied. So far, no single intervention has convincingly improved liver histology. It is recommended that patients at high risk of developing advanced liver disease, and who are not part of controlled studies, should receive nutritional counseling and take physical exercise to achieve moderate weight loss and improve insulin sensitivity. Aerobic activity reduces the risk and improves symptoms. The milk thistle extract silymarin can be of help.

Alcoholic hepatitis is a serious complication of alcohol abuse due to its high mortality rates particularly at short term. It may complicate pre-existing alcoholic fatty liver or cirrhosis and is mainly diagnosed on clinical and laboratory grounds although liver biopsy is occasionally needed to exclude other pathology and confirm the diagnosis. Accumulating evidence suggests that cytokines and immunity are actively involved in its pathogenesis. Management includes abstinence and supportive care. Treatment with corticosteroids has been studied in several clinical trials with conflicting results. However, recent evidence supporting the beneficial effect of TNF-alpha inhibition provides an encouraging alternative. Here we summarise the current state in diagnosis and management of alcoholic hepatitis and briefly review the latest advances in pathophysiology that may lead to new therapeutic strategies for this difficult clinical condition.

Cirrhosis and its disease-related complications are the 12th leading cause of mortality among U.S. adults and are the 5th leading cause of death for individuals aged 45 to 54 years.

Liver disease symptom and sign
Symptoms of liver disease are variable and subtle in the early stages of the problem. Liver disease symptoms include: Poor appetite (anorexia)- Weight loss- Lethargy- Anemia- Light colored stool- Bleeding disorders- Distended abdomen due to ascites or hepatomegaly. Vomiting (emesis), nausea, or diarrhea - Orange colored urine or mucous membranes due to jaundice.

Liver damage from Drugs
There are many medications that can cause harm including stating drugs used for cholesterol. The US FDA noted that three patients using Telithromycin (Ketek) developed serious liver damage.

Liver cleanse
Most people who talk about doing a liver cleanse probably don't know what they mean or attempting to do, and possibly may not realize that they already have a healthy, functioning liver. They may attribute some of their symptoms to a weak liver whereas the problem may lie elsewhere.


Terms used in conjunction with a liver problem or disease:
Cholestasis - reduction or stoppage of bile flow
Hepatic - having to do with the liver
Hepatocyte- individual liver cell
Hepatomegaly - enlarged liver
Hypertrophy- increased size of an organ
Hypoalbuminemia - low albumin
Hypoproteinemia- low protein
Icterus (jaundice) - yellow discoloration of skin or mucous membranes
Jaundice - a yellowish discoloration of the skin and the whites of the eyes

Herbs that could protect liver tissue
Pergularia herb

Herbs associated with possible liver damage
Celandine herb
Kava may harm the liver if used daily

Questions
Q. I am interested in Polycystic Liver Disease and TMG. I am familiar with TMG for fatty liver but I read that TMG can cause the stomach to produce more bile which is a cause of the cysts in the liver to grow. Is it possible DMG, TMG or betaine could cause the liver cysts to grow more rapidly?
   A. We have not seen any research regarding the relationship between polycystic liver disease and trimethylglycine.

Q. Isn't there a concern for the liver when you take lots of supplements?
   A. it is possible that excess of some supplements could place stress on the liver.

Q. Could 5-HTP cause liver damage?
   A. Thus far this has not been reported in the medical literature, but I prefer using small amounts of supplements. In the case of 5-HTP, using it a few times a week at a dosage of 50 mg with a week off each month should not present a liver problem issue.

Q. Would lipoic acid be helpful in liver disease?
   A. I have not seen any research regarding the use of lipoic acid supplement for liver disease.

Q.  I'm new to your web site and learning a lot. I've been using Liv.52 for my liver for some time. I see other things that you recommend for the liver, but not Liv.52. The ingredients in Liv.52 are not in the products that you recommend. What do you think about Liv.52 and why don't you mention it?
   A. We are not familiar with Liv 52. An internet search reveals Liv 52 has these ingredients and the claims made by the company selling it. Capers (Capparis spinosa) - Well-documented hepatic stimulant and protector. Improves the functional efficiency of the liver. Wild Chicory (Cichorium intybus) - Powerful hepatic stimulant, increases bile secretion, acts on liver glycogen and promotes digestion. Black Nightshade (Solanum nigrum) – Promotes liver and kidney health and has shown hepatoprotective activity in cases of toxicity induced by drugs and chemicals. Arjuna (Terminalia arjuna) – Tonic for heart and liver. Regulates hepatic cholesterol biosynthesis. Negro Coffee (Cassia occidentalis) – Digestive and hepatic tonic.  Yarrow (Achillea millefolium) – Stimulative tonic for the liver. Tamarisk (Tamarix gallica) - Hepatic stimulant; also provides digestive support.
   We have created a new article on Liv 52 and provided some of the published research which looks promising. There are countless products on the market that are promoted for liver health and we just can't learn about all of them. There has been a lot study with milk thistle and acetycysteine for liver disease.

Do you know whether mixed carotenes in moderate amounts can be handled by a liver that is diseased? That is, would they accumulate in the liver and do harm; would they still be beneficial to the body?
   The influence or side effect of an herb or natural substance has much to do with the dosage. In most cases small amounts are handled by the body quite well. Liver disease is a broad term and too vague to make any specific or further suggestions regarding the use of carotenoid supplements.

I receive your newsletter and have a question. I'm a 59 year old male in excellent health. I take chrysin and maca to naturally try and enhance testosterone. I just had my blood work done. Everything was fine except for two of my liver tests. My AST (SGOT) and ALT (SGPT) were slightly elevated. The numbers: AST 59, ALT 66. Is it possible that these two supplements could be contributing to the slight elevation? When I last had my blood work done and wasn't taking these, the liver tests were normal. And if these two is causing the slight elevation, is it bad for the liver?
    There are many causes for elevated liver enzymes and it is not possible for me to know the cause in your situation. A good way to find out is to stop the herbs for a month or so and then check the levels of the liver enzymes again. If back to normal, it would be likely that the herbs were involved. If you wish you could retest again after restarting the herbal supplements to see if they are truly the cause of the liver enzyme elevation.