Natural treatments for alcoholic hepatitis

• PRINCIPAL PROPOSED NATURAL TREATMENT: Reduced alcohol consumption

• OTHER PROPOSED NATURAL TREATMENTS: General nutritional support, magnesium, milk thistle, omega-3 essential fatty acids, omega-6 essential fatty acids, S-adenosyl-L-methionine (SAMe), trimethylglycine, silymarin, quercetin, hesperidin, berberine, vitamin E, B-complex vitamins, zinc, diet and lifestyle changes
• HERBS AND SUPPLEMENTS TO AVOID: Beta-carotene (excessive dose), coltsfoot, comfrey, germander, greater celandine, kava, kombucha, pennyroyal, prepackaged Chinese herbal remedies, vitamin A (excessive dose)

DEFINITION: Treatment of liver disease caused by chronic overconsumption of alcohol.

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, commonly abbreviated as SGOT, SGPT, ALT, AST, and GGT, rise as liver damage (from 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 specific treatment beyond this.

Principal Proposed Natural Treatments

Several influences can severely damage the liver, of which alcohol is the most common. This potent 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 five to ten years of heavy alcohol abuse.

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 four weeks. The treated group showed a significant decrease in elevated liver enzymes and improved 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 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. Another 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-adenosyl-L-methionine (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. Silymarin (a flavonoid from Silybum marianum), Isoorientin (a flavone found in buckwheat), and oleanolic acid (a pentacyclic triterpenoid found in herbs, fruits, and vegetables) are natural compounds that have been studied for their potential to reduce oxidative stress, which may support liver health in conditions such as alcoholic hepatitis. Other supplements that have shown promising results in preliminary studies include quercetin, hesperidin, and berberine. Zinc, vitamin E, and B-complex vitamins have also been investigated for liver support, but robust clinical evidence is limited.

Further research is required before medical professionals can routinely recommend these supplements for alcoholic hepatitis. Making diet and lifestyle changes is important for individuals with alcoholic hepatitis. Eating a diet rich in fruits, vegetables, and protein, limiting salt, and avoiding processed food and added sugars may may support liver health. Individuals are strongly advised to abstain from alcohol completely, get adequate rest and hydration, and avoid stress. 

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

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