Liver Cirrhosis

Large amounts of SAMe (S-adenosylmethionine) may improve survival and liver function in alcoholic liver cirrhosis. A double-blind trial found that 1,200 mg of SAMe per day for two years significantly decreased the overall death rate and the need for liver transplantation in people with alcoholic liver cirrhosis, particularly in those with less advanced liver disease.² Preliminary trials suggest that lower amounts of SAMe (180 mg per day in one trial³ and 800 mg per day in another⁴) may improve liver function in people with liver cirrhosis. SAMe supplementation has been shown to reverse the depletion of glutathione, an important antioxidant required for liver function.⁵It has also been shown to aid in the resolution of blocked bile flow (cholestasis), a common complication of liver cirrhosis.^6,7

In a study of people with cirrhosis, supplementing with 10 grams of fermentable fiber per day (containing equal parts of beta-glucan, inulin, pectin, and resistant starch) for 30 days resulted in an improvement in liver function.¹⁰ The impaired brain function that often accompanies cirrhosis of the liver (hepatic encephalopathy) also improved.

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.¹¹ This imbalance may contribute to the development of PSE.¹² BCAA supplementation could be a way to correct this problem, as well as to provide a source of needed protein, but its effectiveness is unclear.¹³ BCAAs (isoleucine, leucine, and valine) represent a good protein source for people with cirrhosis because they are less likely to induce PSE. A controlled study of protein-intolerant people with cirrhosis showed that BCAA supplementation corrected abnormal protein metabolism about as well as an equivalent amount of dietary protein without inducing PSE as frequently.¹⁴ In a small double-blind trial, people with liver cirrhosis taking 5 grams per day of BCAAs had significant improvement in their ability to process protein.¹⁵

However, treatment trials using BCAAs alone or in solutions containing other amino acids in people with cirrhosis and PSE have reported conflicting results.^16,17,18,19 It may be that certain people with liver cirrhosis can benefit from supplementation with BCAAs while others cannot, for reasons that are unclear.²⁰ In a double-blind trial, people with liver cirrhosis and PSE received 0.24 grams per 2.2 pounds body weight (approximately 16–17 grams per day) of BCAAs for 15 days, after which most experienced significant improvement in brain function, mental status, and protein metabolism. Those who continued taking BCAAs for three months also had mild improvement in liver function tests.²¹

Therapeutic effects of oral BCAAs have also been shown in children with liver failure²² and in adults with cirrhosis of the liver without PSE.²³ Overall, it appears that BCAA supplementation does not always help in cirrhosis, but some people with and without PSE may benefit. A qualified doctor must closely supervise such BCAA supplementation.

L-ornithine-L-aspartate (OA) is a nutritional supplement that has been investigated as a treatment for cirrhosis and hepatic encephalopathy. In a double-blind trial, participants taking 18 grams of OA for 14 days had significant improvements in liver function, mental status, and brain function.²⁴ Similar benefits have also been demonstrated using injections of OA.^25,26

An extract of milk thistle (Silybum marianum) that is high in a flavonoid compound known as silymarin may improve liver function and increase survival in people with cirrhosis. Clinical trials have shown that silymarin (420–600 mg per day) improves liver function tests and protects liver cells against oxidative damage in people with alcohol-related liver disease.^27,28,29,30 However, evidence is conflicting regarding the ability of silymarin to prolong survival of people with liver cirrhosis. In one double-blind trial, a significant increase in survival was found in people with cirrhosis who were given 140 mg of silymarin three times a day for approximately two years.³¹ Positive results were also found in a 12-month controlled study of adults with diabetes and alcoholic liver cirrhosis taking the same daily amount of silymarin.³⁰ However, another double-blind trial found that 150 mg of silymarin three times a day for two years had no significant effect on survival among alcoholics with liver cirrhosis.³³

For people with chronic liver disease, milk thistle extract may be taken long-term. Milk thistle extracts containing 80% silymarin are commercially available and may be taken in amounts that deliver 420 mg of silymarin per day.

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.³³ This formula is approved by the Japanese Ministry of Health and Welfare for cirrhosis-induced muscle cramps.

Phosphatidylcholine (PC) breaks down scar tissue in the liver and may be able to reverse tissue changes that cause cirrhosis.³⁴ In animal studies, PC has been repeatedly shown to prevent or reverse the progression of alcohol-induced cirrhosis,^35,36,37 but this has not yet been demonstrated in humans. In a controlled trial, Czech researchers found that PC supplementation (900 mg per day for four months) improved liver function in people with cirrhosis.³⁸

The Chinese herb bupleurum is an important component of the formula known as sho-saiko-to. Sho-saiko-to was shown in one preliminary trial to reduce the risk of liver cancer in people with liver cirrhosis.⁴³ The amount of this formula used was 2.5 grams three times daily.

Alcoholic liver cirrhosis is associated with zinc deficiency.^44,45 In a double-blind trial, zinc acetate supplementation (200 mg three times daily, providing a total of 215 mg of elemental zinc per day), given to cirrhosis patients for seven days, significantly improved portal-systemic encephalopathy (PSE).⁴⁶ A second trial achieved similar results after three months of treatment ⁴⁷ and a third trial found a beneficial effect from 6 months of treatment with 51 mg per day of zinc in the form of zinc L-carnosine complex.⁴⁸ People with cirrhosis sometimes have impaired taste function, and it has been suggested that zinc deficiency may be the cause of this abnormality. Although one study demonstrated that taste problems in cirrhosis are due to the disease process itself and not to zinc deficiency,⁴⁹ a double-blind trial showed that 200 mg three times per day of zinc sulfate (providing 135 mg of elemental zinc per day) for six weeks significantly improved taste function in people with alcoholic liver cirrhosis.⁵⁰ A doctor should supervise long-term supplementation of zinc in these amounts.

L-carnitine injections have been used to improve circulation to the liver in people with cirrhosis,⁵¹ but trials of the oral supplement are lacking.

Selenium levels have been found to be low in people with liver cirrhosis⁵² and the need for antioxidants has been found to be increased.⁵³ A small, preliminary trial suggested that 100 mcg per day of selenium may improve liver function in people with alcoholic cirrhosis.⁵⁴ Larger, double-blind trials of selenium in people with liver cirrhosis are needed.

Vitamin E has been shown to decrease damage in cirrhotic livers and may reduce immune abnormalities that contribute to the development of the disease.⁵⁵ However, a study reported that supplementation of 500 IU per day of vitamin E for one year failed to influence laboratory tests, liver function, survival or hospitalization rates in people with alcoholic cirrhosis.⁵⁶ Further clinical trials are needed to determine if any benefits may be expected from vitamin E supplementation in people with liver cirrhosis.