Vitamins that may be helpful
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.11 Preliminary
trials suggest that lower amounts of SAMe (180 mg per day in one trial12 and 800 mg
per day in another13 ) 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.14 It has also been shown to aid in the resolution of blocked bile
flow (cholestasis), a common complication of liver cirrhosis.15 16
In a double-blind trial, supplementation with
acetylcarnitine (2 grams twice a day for 3 months) improved various measures of mental and
neurological function in people with impaired function (minimal hepatic encephalopathy) due to
cirrhosis.17
In addition to protein deficiency as discussed above, liver cirrhosis is characterized by
low blood levels of branched-chain amino acids
(BCAAs) in relation to other amino
acids.18 This imbalance may contribute to the development of PSE.19
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.20 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.21 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.22
However, treatment trials using BCAAs alone or in solutions containing other amino acids in
people with cirrhosis and PSE have reported conflicting results.23 24
25 26 It may be that certain people with liver cirrhosis can benefit
from supplementation with BCAAs while others cannot, for reasons that are
unclear.27 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.28
Therapeutic effects of oral BCAAs have also been shown in children with liver
failure29 and in adults with cirrhosis of the liver without PSE.30
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.
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.31 The impaired brain function that often accompanies cirrhosis of the
liver (hepatic encephalopathy) also improved.
Phosphatidylcholine (PC) breaks down scar
tissue in the liver and may be able to reverse tissue changes that cause
cirrhosis.32 In animal studies, PC has been repeatedly shown to prevent or reverse
the progression of alcohol-induced cirrhosis,33 34 35 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.36
Alcoholic liver cirrhosis is associated with
zinc deficiency.37 38 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).39 A second trial achieved similar results after three months
of treatment.40 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,41 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.42 A doctor should
supervise long-term supplementation of zinc in these amounts.
People with cirrhosis have decreased secretion of bile acids.43 Supplementation
with bile acids (such as ursodeoxycholic acid and tauroursodeoxycholic acid) may improve the
composition of bile and delay disease progression in primary biliary cirrhosis (PBC). In one
trial, people with PBC were followed for five to nine years. Those who took 13–15 mg per
2.2 pounds body weight of ursodeoxycholic acid (about 900–1200 mg) per day had improved
liver function tests and significantly delayed progression to cirrhosis.44 Several
other trials have confirmed that bile acids improve liver function in people with
PBC.45 46 47 48 49 Commercial
supplements of bile acids are available as ox bile concentrates. However, these ox bile
preparations contain other types of bile acids than those used in PBC research. The
effectiveness and appropriate amount of ox bile concentrates in the treatment of PBC is
unknown.
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.50
Similar benefits have also been demonstrated using injections of OA.51
52
L-carnitine injections have been used to
improve circulation to the liver in people with cirrhosis,53 but trials of the oral
supplement are lacking.
Vitamin E has been shown to decrease damage
in cirrhotic livers and may reduce immune abnormalities that contribute to the development of
the disease.54 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.55 Further clinical trials
are needed to determine if any benefits may be expected from vitamin E supplementation in
people with liver cirrhosis.
Selenium levels have been found to be low
in people with liver cirrhosis56 and the need for antioxidants has been found to be
increased.57 A small, preliminary trial suggested that 100 mcg per day of selenium
may improve liver function in people with alcoholic cirrhosis.58 Larger,
double-blind trials of selenium in people with liver cirrhosis are needed.
People with primary biliary cirrhosis are at increased risk of bone loss. In a preliminary
trial, supplementation with 0.5 micrograms of calcitriol (a prescription form of vitamin D) twice daily for 12 months prevented a loss
in bone mineral density.59 Whether regular vitamin D might also prevent bone loss
in people with PBC is unknown.
Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.
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