Alcoholic Hepatitis

Related Terms

  • AlcoholicLiver Disease
  • Hepatitis, Alcoholic
  • Liver Disease, Alcoholic

Uses

Principal Proposed Natural Treatments

  • ReduceAlcohol Consumption

Other Proposed Natural Treatments

Herbs and Supplements toAvoid

The liver is a marvelously sophisticated chemical laboratory, capable ofcarrying out thousands of chemical transformations on which the body depends.The liver produces some important chemicals from scratch and modifies others toallow the body to use them better. In addition, the liver neutralizes anenormous range of toxins. Without a functioning liver, you cannot live forlong.Unfortunately, a number of influences can severely damagethe liver, of which alcohol is the most common. This powerful liver toxin harmsthe liver in three stages: alcoholic fatty liver, alcoholic hepatitis, then cirrhosis.Although the first two stages of injury are usually reversible, cirrhosis isnot. Generally, liver cirrhosis is a result of more than 10 years of heavyalcohol abuse.Usually, alcoholic hepatitis is discovered throughblood tests that detect levels of enzymes released from the liver. The bloodlevels of these enzymes—known by acronyms such as SGOT, SGPT, ALT, AST, andGGT—rise as damage to the liver (by any cause) progresses.Ifblood tests show that you have alcoholic hepatitis (or any other form of liverdisease), it is essential that you stop drinking. There is little in the way ofspecific treatment beyond this.

Principle Proposed Natural Treatments

Several herbs and supplements have shown promisefor protecting the liver from alcohol-induced damage. However, none of thesehas been conclusively proven effective, and cutting down (or eliminating)alcohol consumption is undoubtedly more effective than any other treatment. Forinformation regarding natural treatments that can help people stop drinking,see the article on alcoholism . The alcoholism article also discusses thedepletion of certain nutrients, which may affect people who consume enoughalcohol to damage the liver. Below, we concentrate on treatmentsused specifically to treat early liver damage caused by alcohol. Treatments formore advanced alcohol-induced liver damage are discussed in the livercirrhosis article.

MilkThistle

Numerous double-blind,placebo-controlled studies enrolling a total of several hundredpeople have evaluated whether the herbmilk thistlecan successfully counter alcohol-induced liver damage. However, these studieshave yielded inconsistent results. For example, a double-blind,placebo-controlled study performed in 1981 followed 106 Finnish soldiers withalcoholic liver disease over a period of 4 weeks. 1 The treated group showed a significant decrease inelevated liver enzymes and improvement in liver structure as evaluated bybiopsy in 29 subjects. Two similar studies enrolling a total ofapproximately 60 people also found benefits. 2,3 However, a 3-month, double-blind, placebo-controlled study of 116 people showedlittle to no additional benefit, perhaps because most participants reducedtheir alcohol consumption and almost half of them stopped drinkingentirely. 4 Another study found no benefit in 72patients who were followed for 15 months. 5 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. 17 A subsequent 2008 review of 19 randomized trials drew a similar conclusion for alcoholic liver disease generally, although it did find a modest reduction in mortality for patients with severe liver cirrhosis . 18 Formore information, including dosage and safety issues, see the full Milk Thistle article.

Other Proposed Natural Treatments

The supplement SAMe has alsoshown some promise for preventing or treating alcoholic hepatitis, but as yetthere is no reliable evidence to support its use for this purpose. 6-9 The supplement TMG helps thebody create its own SAMe and has also shown promise in very preliminarystudies. 10-13

Herbs and Supplements to Avoid

High doses of the supplements beta-carotene andvitamin A might cause alcoholic liver disease to develop more rapidly in peoplewho abuse alcohol. 14,15 Nutritionalsupplementation at the standard daily requirement level should not cause aproblem. See the articles on Vitamin A and Beta-carotene for more information. Although one animal study suggests that theherb kava might aid in alcohol withdrawal, 16 the herbcan cause liver damage; therefore, it should not be used by people withalcoholic liver disease (and probably not by anyone at all). Numerous otherherbs possess known or suspected liver-toxic properties, including coltsfoot,comfrey, germander, greater celandine, kombucha , pennyroyal, and various prepackaged Chinese herbalremedies . For this reason, people with alcoholic liver diseaseshould use caution before taking any medicinal herbs.

References

1
Salmi HA, Sarna S. Effect of silymarin onchemical, functional and morphological alterations of the liver. A double-blindcontrolled study. Scand J Gastroenterol. 1982;17:517-521.

2
Feher J, Desk G, Muzes G,et al. Liver protective action of silymarin therapy in chronic alcoholic liverdiseases [in Hungarian]. Orv Hetil. 1989;130:2723-2727.

3
Fintelmann V, Albert A.Proof of the therapeutic efficacy of LegalonW for toxic liver illnesses in adouble-blind trial [translated from German]. Therapiewoche. 1980;30:5589-5594.

4
Trinchet JC, Coste T, Levy VG, et al. Treatment of alcoholichepatitis with silymarin. A double-blind comparative study in 116 patients[translated from French]. Gastroenterol Clin Biol. 1989;13:120-124.

5
Bunout D,Hirsch SB, Petermann MT, et al. Controlled study of the effect of silymarin onalcoholic liver disease [translated from Spanish]. Rev MedChil. 1992;120:1370-1375.

6
McClain CJ, Hill DB, Song Z, et al.S-Adenosylmethionine, cytokines, and alcoholic liver disease. Alcohol. 2002;27:185-192.

7
Abittan CS, Lieber CS. Alcoholic liverdisease. Curr Treat Options Gastroenterol. 1999;2:72-80.

8
Rambaldi A, Gluud C.S-adenosyl-L-methionine for alcoholic liver diseases. Cochrane DatabaseSyst Rev . 2001;CD002235.

9
Lieber CS, Casini A, DeCarli LM, et al.S-adenosyl-L-methionine attenuates alcohol-induced liver injury in the baboon. Hepatology. 1990;11:165-172.

10
Barak AJ, Beckenhauer HC, Tuma DJ.Betaine, ethanol and the liver: a review. Alcohol. 1996;13:395-398.

11
BarakAJ, Beckenhauer HC, Junnila M, et al. Dietary betaine promotes generation ofhepatic S-adenosylmethionine and protects the liver from ethanol-induced fattyinfiltration. Alcohol Clin Exp Res. 1993;17:552-555.

12
Murakami T, Nagamura Y,Hirano K. The recovering effect of betaine on carbon tetrachloride-inducedliver injury. J Nutr Sci Vitaminol. 1998;44:249-255.

13
Kanbak G, Inal M, BaycuC. Ethanol-induced hepatotoxicity and protective effect of betaine. Cell Biochem Funct. 2001;19:281-285.

14
Leo MA, Lieber CS. Alcohol, vitamin A,and beta-carotene: adverse interactions, including hepatotoxicity andcarcinogenicity. Am J Clin Nutr. 1999;69:1071-1085.

15
Ni R, Leo MA, Zhao J,Lieber CS. Toxicity of beta-carotene and its exacerbation by acetaldehyde inHepG2 cells. Alcohol. 2001;36:281-285.

16
Veh I, Chatterjee SS, Kiianmaa K, et al.Reduction of voluntary ethanol intake in alcohol-preferring AA-rats by kavaextract. Presented at International Congress and 49th Meeting of the Societyfor Medicinal Plant Research; September 2-6, 2001; Erlangen, Germany.

17
Rambaldi A, Jacobs B, Gluud C. Milk thistle for alcoholic and/or hepatitis B or C virus liver diseases. Cochrane Database Syst Rev. 2007;CD003620.

18
Saller R, Brignoli R, Melzer J, et al. An updated systematic review with meta-analysis for the clinical evidence of silymarin. Forsch Komplement Med. 2008;15:9-20.

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