herbal treatment

[hollyhock123]

Livercare/liv.52 has been recommended as a herbal treatment for cirrhosis.  Is there any merit to this or any other remedies?

No medication or treatment has been prescribed for the treatment of my husband's disease.  Doctors just say go home and don't drink alchohol.  

It seems to me that if there is treatments for cancer and other life threatening disease, there should be treatment for cirrhosis.

[hollyhock123]

My husband has quit drinking!  It is a miracle but now he itchs all over.  Is this to be expected??

[hollyhock123]

Is there anything available that I can put in my husbands drinks that will cause him to be sick but not damage his liver.  Aversion Therapy

Or
Is there anything that tastes, smells and has the same effect as vodka but will not damage his liver?

[hollyhock123]

This what I would like for my husband.  A drink that tastes, smells and has the same effect as vodka but does not do any damage to his liver (Note: if this is not available, the person that invents it will not only be a hero but will retire a millionaire.)

If this is not available, I would like something I can put in his drinks that does not have an odor, taste, but will make him sick at his stomach and not damage his liver.  Aversion therapy.

[medicalstudent]

Your husband must totally abstain from alcohol. No drink, not one glass of wine. This is really important.

What is the exact diagnosis from ultrasound? Diagnosing liver cirrhosis by ultrasound isn't possible before the disease has progressed. Just liver biopsy and to a lesser degree fibrosis markers (special blood tests) can be used to diagnose cirrhosis in the very early stages.

Child-Pugh score is used to evaluate the prognosis for people with liver cirrhosis. You can find some info here: http://www.fpnotebook.com/GI44.htm

As already said, the use of herbs/supplements for (alcoholic) cirrhosis remains controversial, abstaining from alcohol is the most important thing. Studies have shown a positive effect for eg. silymarin (active ingredient in milk-thistle) in liver disease (including cirrhosis). But not all studies did.

As for AdoMet (SAM-E): Adenosyle-Methionine production is depressed in people with cirrhosis (especially in people with active alcoholic cirrhosis). Using precursors like betaine (trimethylglycine) doesn't work that well to increase SAM-E production in people with cirrhosis, direct supplementation with SAM-E seems to be a better way.

Intravenous seems to be the best route of administration, but oral supplementation with SAM-E seems to work too if the dose is high enough (and the tablets are enteric-coated).

You can get more info on PubMed, eg. here:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10406187&query_hl=1

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=1095965&query_hl=1

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=1095964&query_hl=1

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=1095962&query_hl=1

You should discuss the option of supplements for alcoholic cirrhosis with an "up-to-date" doctor, a hepatologist would be optimal.

[hollyhock123]

He is 68 and has been drinking around 25 years.  Although not to the extent where he would pass out or become sick.

Since his diagnosis he still has a drink or a glass of wine but not anything like he did before.

He has had the blood tests and an ultra sound.

He has taken milk thistle for years but not sam-e.  Most doctors will not even discuss herbal supplements.  Do you think that he should take sam-e in addition to milk thistle?

Before talking to you I had never heard about the different degrees of cirrhosis.  What does child mean?

Thank you

[hollyhock123]

Is Ado Med the same as Sam-e?

[hollyhock123]

I don't know where he is regarding cirrohis.  He was diagnosed immediately after having hernia surgery last October.  He has retained a large amount of fluid since that surgery.  
I have questioned what happened during his hernia surgery and whether the cirrohis diagnosis is correct.  He did not have many health issues until after the surgery.  The doctors and hospital deny this, of course.  

Anyway, we are willing to try anything to have him regain his health.  Please tell me what supplements we should try and in what doses.

thank you
his wife

[medicalstudent]

How was his liver cirrhosis diagnosed. Ultrasound, liver biopsy or both (the exact diagnosis is really important)? Retaining water can be a complication of decompensated cirrhosis, but it can have other causes too.

I can't really see a link between hernia surgery and cirrhosis. How much alcohol did he drink and for how long, how old is he? Were blood tests done to rule out other causes than alcohol? What do general blood tests show (Bilirubin, Albumin, GOT, GPT, gamma-GT, Quick...)? Have you seen an hepatologist?

Cirrhosis is generally considered irreversible, at least in the end stage. Studies have shown reversal of cirrhosis for people with hepatitis-C and treatment response to anti-viral drugs. There have been some positive case-reports for the drug colcichine as well, but the drug failed in most larger studies for alcoholic-cirrhosis.

Silymarin and AdoMet (SAM-E) will not be able to reverse pre-existing cirrhosis, but they can reduce damage done to the liver and slow down fibrosis, delaying complications. Silymarin is considered a safe natural drug with very few side-effects. Doses used in the studies were: 140mg 3 times a day = 420mg. You should use a standardized quality product from a bigger company. Please ask his doctor if it's ok to take that supplement.

SAM-E was used in doses 400mg 3 times a day = 1200mg. It is really expensive. You should use enteric-coated, blister-packaged tablets from a thrustworthy company. SAM-E shall not be used by bipolar (manic-depressive) people as it can induce mania. It must not be combined with prescription anti-depressants, because of risk of serotonin-syndrome. Please ask your doctor about that supplement.

The most important thing is to abstain from alcohol. Treatment with supplements like silymarin remains controversial as not all studies did you benefits in liver disease. Because of it's very good safety-profile it and it's low price, it might be worth a try. You can have a look about the supplements phosphatidylcholine (in lecithin), lipoic-acid, NAC and selenium for liver disease too and do a little research.

[Kevin Pho, MD]

There has been no data suggesting that these treatments can have any benefit in the treatment of cirrhosis.  

Short of a liver transplant (which is curative), there are various ways to slow the course of progression.  This can include preventing and treating complications (i.e. bleeding, encephalopathy), as well as minimizing superimposed insults to the liver (i.e. abstaining from alcohol, vaccinations to hepatitis etc.).

You can discuss these options with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

[yoshi]

what about liver transplant??

[medicalstudent]

Transplantation is now accepted treatment in alcoholics who have brought their alcoholism under control and who benefit from adequate social support, but the rate limiting factor is still the vastly insufficient donor supply and the prejudice against using this scarce resource in patients with "self inflicted" disease.

Source: http://www.hepnet.com/hepc/uldh99/lieber.html

[medicalstudent]

There was one bigger study on Liv.52 for liver cirrhosis, but the mortality was actually highly increased in the Liv.52 Group when compard with placebo:

Fleig et al. performed a randomized, placebo-controlled, 2-year clinical trial in 188 patients with alcohol-related cirrhosis. LIV.52 did not affect the survival rate of Child class A and B patients but increased mortality among the 59 Child class C patients (81% in the treated group, compared with 40% in the placebo group). Twenty-two of 23 deaths in the LIV.52 group were related to bleeding or liver disease compared with only 3 of 11 deaths in the placebo group. This result led to immediate withdrawal of the drug. It highlights the danger of ill-defined herbal preparations and the necessity for in-depth preclinical testing.

There are only two drugs/supplements I know of which significantly increased life-time in alcoholic-related cirrhosis in good designed studies: Silymarin (from milk-thistle) and Adenosylmehtionine (AdoMet).

Silymarin: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=2671116&query_hl=1

AdoMet: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10406187&query_hl=2

[surgeon]

Don't waste your money. The fact is that there is no direct treatment for cirrhosis to reverse the damage. Depending on how bad it is, there can be improvement by the body's own healing ability, assuming no alcohol touches it again. And there are treatments for the consequences, if they occur.

[medicalstudent]

I forgot to ask: Is it early or end-stage cirrhosis? If decompensated cirrhosis is it Child-A,B or C? Is it only related to alcohol abuse or are there other factors too (eg. viral hepatitis)?

Prognosis for early-stage alcoholic-cirrhosis is not that bad, if alcohol consumption is stopped immediately. Professional help will likely be needed for that goal.