Cirrhosis is a condition of severe damage to the liver that impairs its ability to function normally. In the UK, the most common cause of liver cirrhosis is chronic alcoholism. Liver cirrhosis may also result from chronic viral infection of the liver (hepatitis types B, C, and D) and a number of inherited diseases, such as cystic fibrosis, haemochromatosis and Wilson’s disease. If severe, liver cirrhosis may lead to liver failure. In the Western world, liver cirrhosis is the fifth leading cause of death in people from ages 45 to 65. Another form of cirrhosis – primary biliary cirrhosis (PBC) – damages the bile ducts in the liver and occurs primarily in women over 35 years of age. The cause of PBC is not known.
Many people with cirrhosis have no symptoms for years. Others may have weakness, loss of appetite, malaise, and weight loss. With blocked bile flow, it is common for people with cirrhosis to have jaundice, itching and fatty yellow skin nodules. Later in the disease, there may be massive bleeding inside the throat; brain abnormalities due to accumulation of ammonia in the blood; liver failure; and ultimately death.
Alcoholism is the leading cause of liver cirrhosis in the Western world. Drinking too much alcohol impairs the absorption of several key nutrients, whilst at the same time increases their loss. Therefore, avoidance of alcohol is paramount for people with liver cirrhosis. Alcohol is directly toxic to the liver. In people with alcohol-induced liver cirrhosis, even moderate alcohol consumption increases the risk of portal hypertension – a dangerous blood pressure abnormality in the liver’s circulation.
Adequate protein intake is essential for people with alcoholic liver cirrhosis because this condition often results in significant protein (and general calorie) deficiency. However, people with liver cirrhosis may be unable to tolerate normal amounts of dietary protein because the cirrhotic liver is less able to detoxify ammonia (which is a major product of protein digestion). The amount of protein that can be tolerated by people with cirrhosis varies considerably. Extreme caution must be exercised when changing their protein intake.
Some people with cirrhosis and impaired bile flow (such as in Wilson’s) may have an excess amount of copper accumulate in the liver. If laboratory tests confirm copper excess, most doctors would recommend avoiding foods rich in copper (such as chocolate, shellfish and liver) along with medical treatment to reduce copper stores.
Nutritional supplement treatment options
SAMe – Large amounts of SAMe (S-adenosylmethionine) may improve survival and liver function in alcoholic liver cirrhosis, particularly in those with less advanced liver disease. Lower amounts of SAMe may improve liver function in people with non-alcoholic liver cirrhosis. SAMe supplementation has been shown to reverse the depletion of glutathione, an important antioxidant required for liver function. It has also been shown to aid in the resolution of blocked bile flow (cholestasis), a common complication of liver cirrhosis.
Acetyl-l-Carnitine – In double-blind trials, supplementing with acetyl-L-carnitine improved fatigue and various measures of mental and neurological function in people with impaired function due to cirrhosis.
Beta-Glucan, Inulin, Pectin and Resistant Starch – studies have shown that people with cirrhosis who supplemented with fermentable fibre (containing equal parts of beta-glucan, inulin, pectin and resistant starch) for 30 days resulted in an improvement in liver function. Impaired brain function was also found to improve.
Branched-Chain Amino Acids (BCAA) – In addition to protein deficiency, liver cirrhosis is characterized by low blood levels of branched-chain amino acids (BCAAs) in relation to other amino acids. A controlled study of protein-intolerant people with cirrhosis showed that BCAA supplementation corrected abnormal protein metabolism equally as well as an equivalent amount of dietary protein without inducing encephalopathy (disease of the brain). BCAAs have also been shown to be therapeutically beneficial in children with liver failure.
l-Ornithine-l-Aspartate – double-blind trials have shown that taking OA for 14 days had significant improvements in liver function, mental status, and brain function.
Phosphatidyl Choline breaks down scar tissue in the liver and may be able to reverse tissue changes that cause cirrhosis.
Zinc – liver cirrhosis is associated with zinc deficiency. Double-blind trials have shown that zinc supplementation given to cirrhosis patients significantly improved portal systemic encephalopathy (PSE) – a neuropsychiatric disorder caused by increased blood levels of ammonia.
Bile Acids – People with cirrhosis have decreased secretion of bile acids. Supplementation with bile acids (such as ursodeoxycholic acid and tauroursodeoxycholic acid) may improve the composition of bile and delay disease progression in primary biliary cirrhosis (PBC).
Vitamin E has been shown to decrease damage in cirrhotic livers and may reduce immune abnormalities that contribute to the development of the disease.
Botanical treatment options
Milk Thistle – An extract of milk thistle (Silybum marianum) that is high in the flavonoid compound silymarin may improve liver function and increase survival in people with cirrhosis. Clinical trials have shown that silymarin improves liver function tests and protects liver cells against oxidative damage in people with alcohol-related liver disease.
Peony – to be taken under medical supervision (in the form of the Chinese herb shakuyaku-kanzo-to). One double-blind trial showed that the Chinese formula shakuyaku-kanzo-to (containing white peony and licorice roots) effectively relieved muscle cramps due to cirrhosis of the liver. This formula is approved by the Japanese Ministry of Health and Welfare for cirrhosis-induced muscle cramps.
Sea Buckthorn has been shown to protect the liver from damage and to reduce blood indicators of liver damage in preliminary human studies.
Article contributed by Dr Tracy S Gates, DO, DIBAK, L.C.P.H., Consultant, Pure Bio Ltd. Copyright © Pure Bio Ltd 2023. All rights reserved.
Pure Bio Ltd are a leading UK supplier of the highest quality PURE nutritional supplements, based in Horsham, West Sussex. Proud Winners of Southern Enterprise Awards, Best Nationwide Hypoallergenic Nutritional Supplements Distributor 2022.
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