Introduction
The liver is a sophisticated chemical laboratory, capable of
carrying out thousands of chemical transformations on which the body depends. The
liver produces some important chemicals from scratch and modifies others to allow
the body to use them better. In addition, the liver neutralizes an enormous range
of toxins.
A number of influences can severely damage the liver, of which alcohol is
the most common. This powerful liver toxin harms the liver in three stages:
alcoholic fatty liver, alcoholic hepatitis, and cirrhosis. Although the first two
stages of injury are usually reversible, cirrhosis is not. Generally, liver
cirrhosis is a result of more than ten years of heavy
alcohol
abuse.
Usually, alcoholic hepatitis is discovered through blood tests that detect levels of enzymes released from the liver. The blood levels of these enzymes, which are known by acronyms such as SGOT, SGPT, ALT, AST, and GGT, rise as damage to the liver (by any cause) progresses.
If blood tests show that a person has alcoholic hepatitis (or any other form of liver disease), it is essential that the person stop drinking. There is little in the way of specific treatment beyond this.
Principal Proposed Natural Treatments
Several herbs and supplements have shown promise for protecting the liver from alcohol-induced damage. However, none of these has been conclusively proven effective, and cutting down (or eliminating) alcohol consumption is undoubtedly more effective than any other treatment. Following is a discussion of the treatments used specifically to treat early liver damage caused by alcohol.
Milk thistle. Numerous double-blind, placebo-controlled studies
enrolling several hundred people have evaluated whether the herb milk thistle
can successfully counter alcohol-induced liver damage. However, these studies have
yielded inconsistent results. For example, a double-blind, placebo-controlled
study performed in 1981 followed 106 Finnish soldiers with alcoholic liver disease
over a period of four weeks. The treated group showed a significant decrease in
elevated liver enzymes and improvement in liver structure, as evaluated by biopsy
in twenty-nine subjects.
Two similar studies enrolling approximately sixty people also found benefits. However, a three-month, double-blind, placebo-controlled study of 116 people showed little to no additional benefit, perhaps because most participants reduced their alcohol consumption and almost one-half of them stopped drinking entirely. Another study found no benefit in seventy-two persons who were followed for fifteen months.
A 2007 review of published and unpublished studies on milk thistle as a treatment for liver disease concluded that benefits were seen only in low-quality trials, and even in those, milk thistle did not show more than a slight benefit. A subsequent 2008 review of nineteen randomized trials drew a similar conclusion for alcoholic liver disease generally, although it did find a modest reduction in mortality for persons with severe liver cirrhosis.
Other proposed natural treatments. The supplement
S-adenosylmethionine (SAMe) has also shown some promise for
preventing or treating alcoholic hepatitis, but there is no reliable evidence to
support its use for this purpose. The supplement trimethylglycine helps the body create its own SAMe and has
also shown promise in preliminary studies.
Herbs and Supplements to Avoid
High doses of the supplements beta-carotene and vitamin A
might cause alcoholic liver disease to develop more rapidly in people who abuse
alcohol. Nutritional supplementation at the standard daily requirement level
should not cause a problem.
Although one animal study suggests that the herb kava might
aid in alcohol withdrawal, the herb can cause liver damage; therefore, it should
not be used by people with alcoholic liver disease (and probably not by anyone).
Numerous other herbs possess known or suspected liver-toxic properties, including
coltsfoot, comfrey, germander, greater celandine, kombucha, pennyroyal, and
various prepackaged Chinese herbal remedies. For this reason, people with
alcoholic liver disease should use caution before taking any medicinal herbs.
Bibliography
Abittan, C. S., and C. S. Lieber. “Alcoholic Liver Disease.” Current Treatment Options in Gastroenterology 2 (1999): 72-80.
Leo, M. A., and C. S. Lieber. “Alcohol, Vitamin A, and Beta-carotene: Adverse Interactions, Including Hepatotoxicity and Carcinogenicity.” American Journal of Clinical Nutrition 69 (1999): 1071-1085.
McClain, C. J., et al. “S-adenosylmethionine, Cytokines, and Alcoholic Liver Disease.” Alcohol 27 (2002): 185-192.
Ni, R., et al. “Toxicity of Beta-carotene and Its Exacerbation by Acetaldehyde in HepG2 Cells.” Alcohol and Alcoholism 36 (2001): 281-285.
Rambaldi, A., and C. Gluud. “S-adenosyl-l-methionine for Alcoholic Liver Diseases.” Cochrane Database of Systematic Reviews (2001): CD002235. Available through EBSCO DynaMed Systematic Literature Surveillance at http://www.ebscohost.com/dynamed.
Rambaldi, A., B. Jacobs, and C. Gluud. “Milk Thistle for Alcoholic and/or Hepatitis B or C Virus Liver Diseases.” Cochrane Database of Systematic Reviews (2007): CD003620. Available through EBSCO DynaMed Systematic Literature Surveillance at http://www.ebscohost.com/dynamed.
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