Articles

Liver Disorders

Introduction

The liver, located in the upper right quadrant of the abdominal cavity, is the largest organ in the body. It weighs approximately three to five pounds and is capable of storing about 300 ml of blood at any given time. The principle function of the liver is to filter and detoxify contaminants in the blood. The liver is also a critical metabolic and storage organ.

There are four lobes in the liver: right, left, caudate, and quadrate. The right and left lobes of the liver house lobules, the functional units of the liver. Lobules are clusters of hepatocytes surrounding a central vein. Each lobule is contained by vascular channels called hepatic sinusoids. The hepatic sinusoids nourish the hepatic cells within each lobule and separate the lobules from each other. The hepatic sinusoids are lined with Kupffer cells. Kupffer cells are phagocytes, capable of removing dead cells, bacteria, and foreign objects from the blood moving through the sinusoids.

When the liver is diseased, a number of important regulatory, metabolic, and storage function are compromised. Because of the important and expansive roles of the liver, a diseased liver results in serious illness. Among its major functions, the liver:

    Produces bile salts Metabolizes hormones Metabolizes drugs Synthesizes glucose Forms lipoproteins Converts carbohydrates and proteins to fat Deaminates proteins Synthesizes cholesterol Forms ketones from fatty acids Converts ammonia to urea Synthesizes plasma proteins Synthesizes clotting factors Stores glycogen Stores vitamins and minerals Filters and detoxifies blood Eliminates bilirubin
Cirrhosis is a chronic degenerative condition of the liver characterized by progressive scarring and buildup of fibrous tissue. As the disease progresses, liver function declines. Cirrhosis is a leading cause of death among those aged 45-74 years. There are three types of cirrhosis: post-necrotic, biliary, and portal (alcoholic). Approximately 80 percent of cirrhosis cases are portal. (1) Although the major cause of portal cirrhosis is alcoholism, it also occurs among those who refrain from alcohol intake. Since the majority of alcoholics do not develop cirrhosis, other factors clearly play a role in the development of the disease.

During the development of cirrhosis, the liver undergoes several important alterations. First, fatty deposits develop on the liver. As alcohol displaces fat as fuel, fat that would normally be used as fuel begins to accumulate. Fat buildup in the liver causes it to enlarge, a condition known as alcoholic hepatitis. This enlargement leads to inflammation and destruction of hepatocytes. Lesions develop in patches throughout the liver. Eventually, the liver becomes scarred and distorted by bands of fibrous tissue. Liver function is destroyed and blood flow to the liver is obstructed.

Hepatitis is a term used to describe inflammation of the liver. Hepatitis can be a result of chronic alcohol abuse, certain medications, trauma, or viral infection. Viral hepatitis is caused by infection from one or more viruses, including hepatitis A, B, C, D, and E. These viruses all differ in nucleic acid structure, modes of infection, incubation, pathogenicity, and prognosis. All forms of viral hepatitis can cause acute illness; some may result in cirrhosis or carcinoma of the liver.

The danger of transmission of hepatitis is high. People can be chronically infected and asymptomatic, unwittingly passing the virus to others. Some may become asymptomatic carriers, never realizing they have been exposed. Those at greatest risk for transmission of viral hepatitis are health care workers and students, dentists, dental hygienists, and anyone regularly exposed to infectious diseases. Other than strict adherence to universal precautions and proper sanitation, vaccinations offer the greatest protection against certain strains of the viruses.

Hepatitis A virus (HAV) is transmitted by the oral-fecal route from direct or indirect contact with feces. HAV infection is common in regions with poor sanitation and waste disposal, in which drinking water is contaminated with sewage. HAV is also spread by contamination of food by infected persons. Hepatitis A infection is asymptomatic in 90 percent of cases. Exposure and subsequent recovery result in lifelong immunity. Those at high risk are international travelers, household or sexual contacts of infected persons, and those residing in facilities with inadequate sanitation or high rates of infection. Children are particularly vulnerable to HAV infection. The hepatitis A vaccine is a highly effective prevention tool. Good hygiene and sanitation practices are other primary prevention measures.

Hepatitis B virus (HBV) is transmitted through contact with infected blood or body fluids. In the majority of infected individuals, symptoms are mild or absent. Approximately 15 to 20 percent experience joint pain, and 10 percent develop jaundice. Ten percent of those infected develop chronic HBV. Active chronic HBV infection is associated with high risk of developing cirrhosis. Those at highest risk of transmission are sexually active heterosexuals, homosexual men, neonates born to infected mothers, health care workers, and IV drug users. Incidence of hepatitis B has decreased since the introduction of the HBV vaccine among the general population, but has increased since 1993 among the sexually active and IV drug risk groups. Prevention is aimed at vaccinations, screening of blood, organ, and tissue donors, and universal precautions among health care workers.

Hepatitis C (HCV) is the most common form of chronic viral hepatitis. (2) Seventy-five to eighty-five percent of those infected with HCV develop chronic infections. Approximately 65 percent of these develop active liver disease, and 10-20 percent will develop cirrhosis within 30 years. (3) HCV is transmitted in the same manner as HBV, affecting the same risk groups. Prevention is targeted at high-risk behavior modification, screening of donors, and universal precautions. There is no vaccine available for HCV.

The most serious type of viral hepatitis, hepatitis D, is caused by infection of the hepatitis delta virus (HDV). Although hepatitis D accounts for a small percent of chronic viral hepatitis infections, the majority of cases lead to chronic liver disease including chronic active hepatitis and cirrhosis. (4) HDV can only occur among patients with HBV who are positive for the HBs-antigen. The HBV vaccine provides protection against HDV. Other identified strains of viral pathogens include hepatitis E and G, although clinical presentation, cause, and sequelae are not well understood at this time.

Statistic

World Health Organization, 2000.

  • The majority of the worldwide hepatitis burden, with subsequent chronic hepatitis, cirrhosis and liver cancer is due to hepatitis virus B (HBV), about 1.2 million people worldwide each year.

National Center for Health Statistics and the American Liver Foundation, 1998.

    One in every 250 persons is a carrier of the hepatitis B virus. About 150,000 people are infected with hepatitis C each year. Cirrhosis is the 7th leading disease related cause of death in the US. 22,000 pregnant women are carriers of hepatitis B each year.

Signs and Symptoms

[span class=alert]The following list does not insure the presence of this health condition. Please see the text and your healthcare professional for more information.[/span]

The symptoms of cirrhosis are varied and their onset gradual. Many patients are asymptomatic until the late stages of the disease. Early symptoms include weight loss, fatigue, nausea, and vague abdominal pain. Later symptoms are more disease specific. Ascites, or fluid buildup in the abdominal cavity, can enlarge the abdomen to twice its normal size. Collateral veins are formed to bypass the liver and allow blood from the GI tract to return to the heart. The collateral veins that develop in the esophagus and stomach may rupture, leading to massive, often fatal, hemorrhage. The spleen may become enlarged and the abdomen tender. The failure of the liver to carry out its many important functions leads to a variety of symptoms. Jaundice is common. Mental confusion, encephalopathy, and hepatic coma can occur from a build up of toxins (particularly ammonia) normally metabolized by the liver. The kidneys may be unable to keep up with their heightened metabolic load, leading to renal failure. Other complications associated with liver failure include skin disorders, endocrine malfunction (including sterility, impotence, and menstrual abnormalities) and anemia.

Signs and symptoms for all forms of hepatitis are similar, although symptoms of HBV are usually the most severe. Initially, many of those infected are asymptomatic. Early signs include headache, fatigue, loss of appetite, fever, and weakness. Signs progress to nausea, indigestion, flatulence, and intolerance of chemical odors. Jaundice is the classic manifestation of hepatitis, caused by an accumulation of bilirubin in the blood. It results in the yellowing of the skin, eyes, and mucous membranes. Jaundice is often accompanied by light, clay colored stool and dark urine. The liver and spleen may become enlarged.

General

    Jaundice Mental confusion Encephalopathy Renal Failure may be present Skin disorders Endocrine malfunction (including sterility, impotence, and menstrual abnormalities) Anemia

Cirrhosis

    Weight loss Fatigue Nausea Vague abdominal pain Ascites Formation of collateral veins Enlarged spleen Many patients are asymptomatic until the late stages of the disease

Hepatitis

    Headache Fatigue Loss of appetite Fever Weakness Nausea Indigestion Flatulence Intolerance of chemical odors Jaundice Liver and/or spleen may become enlarged Initially, many of those infected are asymptomatic

Treatment Options

Conventional

Treatment for cirrhosis is aimed toward reducing further insult to the liver, nutritional support, and comfort measures.

    Alcohol and drugs, especially those metabolized by the liver (acetaminophen) are contraindicated. Sodium intake is restricted and potassium-sparing diuretics are used to manage fluid buildup associated with ascites. Antacids are prescribed to reduce gastric acid and prevent GI bleeding. Antibiotics are given to reduce the ammonia-producing bacteria in the GI tract. Lactulose may be given to help lower the bowel pH and convert ammonia to ammonium ions. (5) Ammonium ions are not absorbed by the blood. The anti-inflammatory drug colchicine, traditionally used in the treatment of gout, has been shown to improve symptoms and increase length of survival in some patients. (6) Colchicine is currently being tested as an antifibrotic. (7)

There is no cure for hepatitis. The acute illness can take two to six months to resolve, and leaves the patient with varying risk for developing chronic liver disease and hepatocellular carcinoma. Acetaminophen and other agents metabolized by the liver are contraindicated during acute illness. Alcoholic beverages should be avoided. Antiviral agents are the only course of treatment for chronic hepatitis. The goal of therapy is to normalize alanine aminotransferase levels and inhibit viral replication.

    Alpha-interferon: Although it is effective in only a small group of patients with chronic hepatitis B, alpha-interferon is the antiviral agent mostly widely prescribed for the disease. (8) Interferon is a glycoprotein synthesized by the body in response to viral infection. Interferons alter the metabolism of non-infected cells and prevent the virus from spreading. They also stimulate the immune system to destroy and remove infected cells and viral contaminants. Alpha-interferon is made by recombinant DNA technology. Its effectiveness is limited, however, because it does not provide long-term protection. Lamivudine, an agent in a new class of antiviral drugs, appears to be very effective and well tolerated among those with hepatitis B infection. Studies indicate that lamivudine suppresses viral replication, reduces serum HBV DNA, and increases Hbe antigen seroconversion. (9) Lamivudine is effective among patients who have failed to respond to alpha-interferon. It also appears to be extremely safe. The Center for Liver Disease at the University of Miami School of Medicine recently reported that lamivudine, "should now be considered the drug of choice for most patients who require treatment." (10)

Nutritional Supplementation


S-Adenosylmethionine (SAMe)

S-adenosyl-L-methionine (SAMe) functions in a variety of ways to protect and support liver function. The established biochemical effects of exogenous S-adenosyl-L-methionine are diverse and are still being explored for use in liver disease. Its proposed therapeutic effects could be exerted via different mechanisms. The established deficiency of SAMe synthetase in cirrhosis could be bypassed by exogenous SAMe, leading to increased levels of sulfur-containing amino acids and glutathione, which would protect against oxidant stress and drug-induced hepatotoxicity (for example, paracetamol).

Furthermore SAMe could act by improving membrane fluidity, and potentially improve or restore the function of receptors, enzymes, and transporters in the cell surface. Membrane fluidity is known to be affected by alterations in cell membrane lipid composition in chronic liver disease. Very few therapeutic agents are effective for the symptomatic or specific treatment of chronic liver disease. SAMe has established biochemical and biophysical effects, which in pilot studies, ameliorate symptoms and biochemical parameters of cholestasis. Moreover, abnormalities in liver function tests (including transaminase values) also improve. Although it is known to provide a variety of hepatoprotective effects, long-term controlled clinical trials of SAMe are needed to assess the true levels of its benefits for patient symptoms, well being, histological changes, and progression of liver disease. (11)

A randomized, double-blind, placebo-controlled trial was conducted with 123 patients with alcoholic cirrhosis who took either SAMe (1,200 mg/day, orally) or placebo for two years. The overall rate of liver transplantation or mortality was significantly greater in the placebo group (29 percent) than in those taking SAMe (12 percent). The results of this study indicate that long-term treatment with S-adenosyl-L-methionine may improve survival or delay liver transplantation in patients with alcoholic liver cirrhosis, especially in those with less advanced liver disease. (12)


N-Acetyl Cysteine (NAC)

N-acetylcysteine (NAC) is one of the more recognized agents to protect the liver and to help with detoxification and regeneration after the liver has been damaged. One of NAC’s more important functions is its ability to regenerate glutathione, which plays a role as an antioxidant, supports adequate immune status, and is part of the phase II detoxification system.

N-acetylcysteine (NAC), the acetylated variant of the amino acid L-cysteine, is an excellent source of sulfhydryl (SH) groups, and is converted in the body into metabolites capable of stimulating glutathione (GSH) synthesis, promoting detoxification, and acting directly as free radical scavengers. Administration of NAC has historically been as a mucolytic agent in a variety of respiratory illnesses; however, it appears to also have beneficial effects in conditions characterized by decreased GSH or oxidative stress, such as HIV infection, cancer, heart disease, and cigarette smoking. An 18-dose oral course of NAC is currently the mainstay of treatment for acetaminophen-induced hepatotoxicity. N-acetylcysteine also appears to have some clinical usefulness as a chelating agent in the treatment of acute heavy metal poisoning, both as an agent capable of protecting the liver and kidney from damage and as an intervention to enhance elimination of the metals. (13)

N-acetylcysteine has proven to be a life-saving therapy in the protection of the liver and kidneys against Amanita mushroom poisoning. (14) It helps detoxify and protect against numerous other life-threatening challenges such as acetaminophen poisoning, (15) mercury toxicity, (16) and doxorubicin toxicity. (17) Dosing of NAC is typically 1-3 grams daily.


Alpha-Lipoic Acid (ALA)

Lipoic acid is another power protector of liver function. It is now recognized as one the most effective agents to treat mushroom poisoning. Alpha-lipoic acid is an excellent antioxidant and is important as a coenzyme for the production of acetyl coenzyme alpha-dihydrolipoic acid, which is the reduced form of alpha-lipoic acid. This serves as an electron donor that recycles other antioxidants. Vitamin C is directly recycled by dihydrolipoic acid. Lipoic acid has been noted to have metal chelating activity. Alpha-lipoic acid has been reported to inhibit HIV replication in cultured T cells, prevent cataracts of the lens, protect the kidney from aminoglycoside damage, protect islet cells in the pancreas from inflammatory attack, inhibit thymocyte apoptosis, and increase helper T cells in the blood. The toxic side effects of vincristine chemotherapy have been reduced with the use of alpha-lipoic acid. Alpha-lipoic acid has been shown to be of benefit in diabetic neuropathy. In Europe, alpha-lipoic acid has been used as a treatment for a variety of different liver diseases. (18)

It has been reported that the half-life of lipoic is about 30 minutes in humans. (19) Recently timed-release lipoic acid products have begun to be marketed, which have a half-life of several hours.


Selenium

Selenium is an important immune system nutrient because four atoms of selenium are necessary for every molecule of the antioxidant enzyme glutathione peroxidase. In an evaluation of 19 hospitalized patients with alcoholic cirrhosis, plasma selenium levels were found to be significantly lower in the alcoholic cirrhosis patients than in healthy controls. Liver function was lower than normal in cirrhosis patients, which correlated with plasma selenium. Among 10 patients who completed selenium supplementation at 100mcg/day, plasma selenium levels were significantly increased compared to the controls, and liver function improved. (20)

A study from China reported on selenium’s ability to protect against liver cancer. Table salt fortified with 15 ppm of anhydrous sodium selenite for five years was compared to control townships using normal table salt. Another trial was among hepatitis B virus surface antigen carriers receiving 200mcg of selenium in the form of selenized yeast daily versus placebo for four years. The third trial was in members of the family with high primary liver cancer incidence using selenium from yeast at 200mcg of selenium daily versus placebo for two years. The results reported that selenium supplementation could reduce the incidence of primary liver cancer significantly. This reduction in primary liver cancer was within a relatively short term period of selenium supplementation. The susceptibility to cancer may be enhanced by low selenium status. (21)


L-Glutamine

Glutamine enhances host defense and is important in the synthesis of glutathione, which is a major antioxidant and protects tissues from free radical injury. In animals that were subjected to acetaminophen poisoning, glutamine supplemented nutrition preserved hepatic glutathione, protected the liver, and improved survival during acetaminophen toxicity. Glutamine enhances host defenses by stimulating antioxidant protection. (22)

Animal studies indicate that glutamine can assist in liver regeneration. (23)


Vitamin C, Vitamin E

Vitamin C and vitamin E are antioxidants that may help protect the liver. This was demonstrated in animal experiments where laboratory rats were administered toxic doses of carbon tetrachloride. The livers in the animals that were pretreated with either vitamin C (24) or vitamin E (25) were substantially protected from tissue injury that normally produces this toxic substance.


Zinc

Zinc depletion is a common occurrence in patients with various forms of liver disease such as hepatitis, alcoholic liver disease, hepatic encephalopathy, and cirrhosis. (26) , (27) Because zinc participates in so many biochemical events in the body, it is generally felt that when zinc depletion is encountered in patients with various forms of liver disease, steps should be taken to replete zinc status. However, there is a lack of clinical trials in this area.

Herbal Supplementation


Milk Thistle

Historically, milk thistle was used as a digestive tonic; a general tonic for the spleen, stomach, and liver; for the gallbladder; to promote bile flow; and as a stimulant for milk flow in nursing mothers. (28) Milk thistle is also used as a hepatoprotective agent and for the treatment of various liver disorders. (29) , (30) The active constituents of milk thistle are a combination of three substances, silybin, silydianin, and silychristin, which collectively are reported to exert hepatoprotective activity. (31)

Silymarin reportedly acts by inhibiting the passage of toxins into the liver cells, by altering the membranes of the hepatic cells, and by stimulating regeneration of new liver cells through increased protein synthesis. (32) Silymarin has been demonstrated to increase glutathione content in the liver by more than 35 percent, increasing its antioxidant capacity. (33) Milk thistle is also reported to inhibit inflammatory enzymes, known as leukotrienes, which would normally lead to the destruction of liver tissue. (34) Because of its reported liver enzyme and cell protection capabilities, it is used in a wide variety of conditions, such as chemical-induced liver damage (including industrial chemicals, alcohol, and pharmaceutical drugs), hepatitis, gallbladder dysfunctions, and psoriasis. (35) , (36)


Picrorhiza

Picrorhiza is a perennial herb that grows in the Himalayas in Asia, at altitudes of 9,000-15,000 feet above sea level. The underground parts of this plant have been used in the traditional Indian systems of medicine since ancient times to treat liver troubles and bronchial problems. Picrorhiza has been used by traditional Ayurvedic medicine of the Hindu to treat the lungs as well as infectious diseases, to reduce fevers, and alleviate indigestion. Recently, researchers and clinicians have reported the value of picrorhiza as an immune-enhancing agent, both with the rhizome and the leaf.

Like milk thistle, picrorhiza may have an effect on liver regeneration. A 1992 study demonstrated stimulation of nucleic acid and protein synthesis in rat liver with oral administration of picrorhiza. The authors stated the results were comparable to milk thistle. (37)

There have been over 15 studies conducted in laboratory animals regarding the effectiveness of standardized picrorhiza as a supplement in liver health. Studies report picrorhiza beneficial for the liver, including viral hepatitis and exposure to hepatotoxic chemical agents, including alcohol and acetaminophen. (38) , (39) , (40) , (41) Another factor in the hepato-protection of picrorhiza may be its anti-inflammatory effects, which is discussed below.

Picrorhiza was evaluated as a hepato-protective agent against ethanol-induced hepatic injury in rats. (42) There was also an effect on specific alcohol-metabolizing enzymes (aldehyde dehydrogenase, 41 percent; acetaldehyde dehydrogenase, 52 percent) in rat hepatocytes. The levels of these enzymes were found to be reduced in the cells following alcohol intoxication.

Several hepatotoxins, including paracetamol and ethynylestradiol, have a cholestatic effect on the production of bile. Picrorhiza has been reported to reverse acetaminophen and ethynylestradiol-induced cholestasis, maintaining both bile volume and flow. Milk thistle was tested simultaneously for comparison. Picrorhiza was found to be a more potent choleretic and anticholestatic agent than milk thistle. (43) Ethyl alcohol also produces cholestasis to varying degrees, as indicated by reduction in bile volume, bile salts, and bile acids. Picrorhiza treatment has been reported to restore these altered parameters in a dose-dependent manner. (44) In a randomized, double-blind placebo controlled trial in patients diagnosed to have acute viral hepatitis (HBsAg negative), picrorhiza root powder 375mg, three times a day, was given for two weeks. (45) Picrorhiza was reported to significantly decrease lab values of bilirubin, SGOT, and SGPT as compared to placebo. The time in days required for total serum bilirubin to drop to an average value of 2.5mg% was 75.9 days in placebo compared to 27.44 days in picrorhiza group. Also, the active principles picroside I, catalpol, kutkoside, and kutkoside 1 were tested for the presence of anti-hepatitis B virus surface antigen (anti HBs)-like activity in vitro. (46) A promising anti-HbsAg-like activity was noted which differed from the classical viral neutralization. Picrorhiza also inhibited purified HBV antigens prepared from healthy HBsAg carriers from binding in vitro.

As an antioxidant for the liver, picrorhiza is reported to protect against changes in liver and brain glutathione metabolism, improving reduced glutathione levels, and decreasing inhibition of glutathione-S-transferase, glutathione reductase, and glutathione peroxidase. (47) The increased levels of lipid peroxidation products in damaged tissues were also reduced along with the recovery of glutathione metabolism. Also, picrorhiza possesses the properties of antioxidants that appear to be mediated through activity like that of superoxide dismutase, metal ion chelators, and xanthine oxidase inhibitors. (48) Picrorhiza does seem to alter cytochrome P-450 enzyme levels, so caution should be used with medications that are metabolized in the liver. (49)


Schisandra

Schisandra has been used in Chinese medicine for centuries as a kidney tonifying agent and sedative. It has historically been used to treat cough and wheezing, spontaneous sweating, chronic diarrhea, insomnia, and forgetfulness. (50) In Russia, schisandra has been used as an adaptogen, increasing the body’s natural ability to fight off disease and stresses from chemical, physical, mental, and environmental sources. (51) Schisandra has been reported to increase human endurance and mental and physical performance. (52)

Recent literature has focused on schisandra’s ability to protect the liver from damaging toxins. (53) , (54) Liver regeneration was reported in laboratory animals following partial hepatectomy. (55) Other uses include as an expectorant and cough suppressant and as an antioxidant. Schisandra was reported to have a cardioprotective action during administration of doxorubicin. (56)

Schisandra and its lignans have been reported to prevent liver damage, stimulate liver repair, and stimulate normal liver function. (57) , (58) These properties are thought to be related to the antioxidant ability of the schisandrins: stimulation of liver glycogen synthesis, protein synthesis, protection of hepatocyte cell membranes, and elevation of liver microsomal drug-metabolizing enzyme activities. (59) , (60)

In clinical studies, schisandra reportedly reduced elevated serum glutamic-pyruvic transaminase (SGPT) levels in various types of hepatitis. However, SGPT levels rebounded after stopping the herb, especially in chronic persistent hepatitis. (61)


Artichoke

The flower head of the globe artichoke has been used as a food and medicinal agent for centuries. In medicine, the globe artichoke has historically been used for poor digestion, along with "sluggish" liver, atherosclerosis, elevated cholesterol levels, and as a mild diuretic. It has reportedly been used in Europe since Roman times as a choleretic and diuretic. Artichoke leaf is claimed to be a potent antioxidant. (62)

Much of the pharmacological activity of the leaves has been attributed to the presence of cynarin, but chlorogenic acid has also been reported to be active in the body, particularly as an antioxidant. (63) The relative proportion of these compounds varies with the strain, age, and generation of the plant. Cynarin is found in highest concentrations in the leaves. (64)

Artichoke has been reported to have significant liver protecting and regenerating effects. (65) In one study, the authors concluded that artichoke had hepatoprotection after exposure of laboratory animals to the liver toxic substance tert-butylhydroperoxide. (66) Some of the hepatoprotective qualities of artichoke seem to be linked to its antioxidant capacity, due mainly to the chlorogenic acid content in the leaves. Another possibility for its liver protection function is the cynarin content, which is claimed to restore healthy growth and reproduction of liver cells. (67)

Artichoke is also reported to have a stimulant activity on bile production in the liver; this is termed choleretic action. (68) Stimulating the flow of bile juices aids in breaking down hard to digest fats, thereby increasing digestion and the absorption of nutrients. Studies have reported that when patients with dyspeptic complaints take artichoke as a supplement, symptoms rapidly disappear, reducing pain, nausea, retching, and the sensation of fullness. (69) The constituent cynarin has been stated to be most active in this capacity.

Artichoke products have been reported to lower blood cholesterol and triglyceride levels in humans and animals. (70) The net effect of artichoke is claimed to be the result of both an inactivation of and an interference with cholesterol metabolism. Cynarin reportedly decreases the rate of cholesterol synthesis in the liver, enhances biliary excretion of cholesterol and increases conversion towards the bile acids. (71) There have been a few reports that artichoke has no lipid reducing effect in familial Type II hyperlipoproteinemia. (72)

Acupuncture & Acupressure

Liu adopted otopoint pressure therapy to treat 56 cases of infantile acute icterohepatitis, including 45 cases of virus hepatitis A, 9 cases of hepatitis B, and 2 cases of mixed type (A and B) hepatitis. These patients were randomly divided into a treatment group (26 cases) and a control group (30 cases). In the treatment group, all patients received treatment on these otopoints: Gan (MA-SC 5), Pi (MA-IC), Jiao Gan (MA-AH 7), Nei Fen Mi (MA-IC 3), Yi (MA-SC 6), Dan (EX-LE 6), and Wei (MA-IC). In addition, depending on the patients’ symptoms, they also received supplemental treatment as follows: treatment on San Jiao (MA-IC 4) for excessive dampness, and on Er Shen Men (MA-TF 1) and Pi Zhi Xia (MA-AT 1) for severer abdominal pain. Details of the treatment: after routine sterilization, vaccaria seeds were adhered to the otopoint areas using small pieces of adhesive plaster. Moderate pressure was applied to these areas (e.g., with a thumb) both clockwise and counterclockwise 3 times a day. The two ears alternated in receiving the treatment every other day, and five sessions constituted one course of treatment. Patients in the control group were treated with a Western medicine. The results: after 2 courses of treatment, of the treatment group and the control group, respectively, 16 (61.54%) and 14 cases (46.67%) recovered, 9 and 15 cases improved, and 1 case in each group did not respond to the treatment. (73)

Traditional Chinese Medicine

Liver Disorders

Extensive information regarding the treatment of this health condition using Traditional Chinese Medicine is available through the link above.

Diet & Lifestyle

Limiting animal protein, avoiding refined sugars and carbohydrates, and increased intake of fresh vegetables, fruits, and whole grains. Limit soda intake as well.

Clinical Lab Assessment

Some of the following laboratory testing can provide information necessary for diagnosis and treatment. In addition, the tests listed may also give insight to functional metabolism and functional nutrient status in the body.

Chemistry Profile (Blood)

A multifactorial assessment of chemistry profile values can reveal useful information regarding concurrent disorders and possible nutrient imbalances.

CBC

A CBC may suggest the involvement of secondary infections, inflammation, and/or nutrient deficiencies. Iron imbalance has long been thought to contribute to the incidence of liver disorders. (74) Mean corpuscular volume (MCV) may not be sufficient to assess iron status. Analysis of serum iron, total iron binding capacity, and ferritin may be indicated.

Liver Enzymes

The enzymes alanine amino transferase (ALT, SGPT), aspartate aminotransferase (AST, SGOT), and lactate dehydrogenase (LD, LDH), usually components of even basic chemistry profiles, are all useful in assessing tissue damage. Several of these values can be used in a correlative analysis to monitor trends in functional abnormality long before pathology becomes clearly apparent. ALT, AST, and LD irregularities can demonstrate abnormalities from various etiologies.

Oxidative Stress

Increased oxidation is a documented dynamic accompanying liver disorder. Oxidant levels increase in relationship to P-450 enzyme detoxication functions. Antioxidants exhibit a protective effect on the liver. Most medications used for the treatment of liver disorders deplete a variety of nutrients, most notably the B vitamins and CoQ10. (75) CoQ10 has been studied as a marker for liver dysfunction contributing to hyperlipidemia. (76) Monitoring of oxidant stress may be useful.

Clinical Notes

    Plant sterolins and sterinols may provide immunomodulating effects. Arabinoxylane may increase NK, T killer, and B cell activity, making a positive impact on viral load.

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