Liver Disease

Cirrhosis is irreversible chronic injury of the liver. It often has no symptoms. Your health care provider will diagnose cirrhosis based on your medical history a physicial examination and laboratory tests.

Signs and Symptoms

The signs and symptoms of cirrhosis can range from an absence of symptoms (in 10 to 20 percent of patients) to liver failure. Cirrhosis can also have symptoms such as jaundice (yellowing of the skin) weight loss abdominal pain testicular atrophy (in men) menstrual irregularity (in women) swelling and fluid in the abdomen and enlarged veins.

What Causes It?

The most common cause of cirrhosis is alcoholism. Consuming a lot of alcohol daily (32 to 48 oz. of beer 4 to 8 oz. of liquor 16 to 32 oz. of wine) for 10 years or more increases your chances of developing cirrhosis. How much alcohol you drink and for how long are more important than the type of alcohol ingested. Between 5 and 10 percent of people in the United States are alcoholics. Of these 10 to 15 percent will develop liver disease. Cirrhosis can also be caused by the ingestion of drugs and toxins infections inherited medical conditions and cardiovascular diseases. About 10 percent of cases have no known cause.

What to Expect at Your Provider's Office

Your health care provider will take a detailed history in order to differentiate your liver disease from other conditions (obesity hepatitis diabetes mellitus biliary obstruction drug toxicities infections and other types of cirrhosis). Your provider will order a complete blood count and liver function tests; in addition he or she may order a liver biopsy. And finally if your cirrhosis is caused by alcoholism your provider will strongly urge you to stop drinking and will counsel you as to the risks you are taking by continuing to drink. He or she may suggest Alcoholics Anonymous as a good place to start your rehabilitation.

Treatment Options

Treatment Plan

Treatment begins by trying to remove factors that caused the cirrhosis such as alcohol or a preexisting disease. This can help to prevent both complications and further damage. Your health care provider may talk with you about diet changes such as protein water and salt restriction. To avoid malnutrition it is important to maintain a well-balanced diet of 2 000 to 3 000 calories. In severe cases surgery or liver transplant may be necessary.

Drug Therapies

Prescription

• Colchicine—slows the progression of the disease
• Diuretics—help to reduce fluid buildup; must be used with caution as serious side effects such as electrolyte imbalances and death can occur
• Neomycin—reduces ammonia production in the intestines which can cause degenerating brain disease (encephalopathy)
• Lactulose—reduces ammonia levels that cause hepatic encephalopathy which can result in disturbances in consciousness or deep coma

Over the Counter

N/A

Complementary and Alternative Therapies

Have much to offer in the treatment of liver disease.

Nutrition

• B-complex: B₁ (50 to 100 mg) B₂ (50 mg) B₃ (25 mg); B₅ (100 mg); B₆ (50 to 100 mg) B₁₂ (100 to 1 000 mcg) folate (400 mcg per day) to reduce deficiencies common in liver disease
• Antioxidants: Vitamin C (1 000 to 3 000 mg per day) vitamin E (400 to 800 IU per day) and selenium (200 mcg per day) reduce toxic effects of alcohol and drugs and prevent tissue damage.
• Essential fatty acids are anti-inflammatory; dietary manipulation includes reducing animal fats and increasing fish and nuts. A mix of omega-6 (evening primrose) and omega-3 (flaxseed) may be best (1 tbsp. oil per day or 1 000 to 1 500 mg per day).
• Choline lecithin methionine (1 g each per day) for fat absorption
• Carnitine (300 mg per day) prevents fatty liver.
• Glutathione (500 mg twice a day) helps remove ammonia from the brain a complication of cirrhosis.
• Vitamin K is necessary for blood clotting; often depleted in cirrhosis
• Desiccated liver (500 mg three times per day) helps provide nutrition to promote liver repair.
• Restrict intake of protein to 45 g per day as long as a minimum of 400 g of carbohydrates is ingested daily.
• A change from animal to vegetable protein may be helpful.

Herbs

As with any therapy it is important to work with your health care provider on getting your problem diagnosed before you start any treatment. Herbs may be used as dried extracts (capsules powders teas) glycerites (glycerine extracts) or tinctures (alcohol extracts). Unless otherwise indicated teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers and 10 to 20 minutes for roots. Drink 2 to 4 cups per day.

Due to the high doses required and the need to avoid alcohol the preferred form of these herbs is powdered.

• Milk thistle (Silybum marianum): 100 mg three times per day prevents free radical damage in the liver.
• Barberry (Berberis vulgaris): 250 to 500 mg per day corrects metabolic abnormalities in liver cirrhosis.
• Catechin (Uncaria gambir): 400 mg three times per day is antioxidant antiviral and helps regenerate liver tissue.

Homeopathy

Homeopathy may be useful as a supportive therapy.

Physical Medicine

Castor oil pack. Used externally castor oil is a powerful anti-inflammatory. Apply oil directly to skin cover with a clean soft cloth (for example flannel) and plastic wrap. Place a heat source (hot water bottle or heating pad) over the pack and let sit for 30 to 60 minutes. For best results use for three consecutive days. Apply pack over liver. Preliminary study shows immune enhancement in healthy patients; was historically used to stimulate liver function.

Acupuncture

May be helpful to alleviate symptoms and increase physiological functioning.

Massage

May help alleviate stress and lymph congestion.

Following Up

Your health care provider will supervise and manage your condition over the long term because cirrhosis can have serious and life-threatening complications particularly if you continue to drink.

Special Considerations

Survival and management of cirrhosis is possible especially with proper treatment. Your health care provider will use caution when prescribing medications if you have cirrhosis because many medications cause complications in someone with a weakened liver.

Supporting Research

Bartram T. Encyclopedia of Herbal Medicine. Dorset England: Grace Publishers; 1995:295.

Bone K. Clinical Applications of Ayurvedic and Chinese Herbs. Queensland Australia: Phytotherapy Press; 1996:69.

Branch WT. Office Practice of Medicine. 3rd ed. Philadelphia Pa: WB Saunders; 1994:326–338.

Fauci AS Braunwald E Isselbacher KJ et al eds. Harrison's Principles of Internal Medicine. 14th ed. New York NY: McGraw-Hill; 1998:1704–1710.

Ferenci P Dragosics B Dittrich H et al. Randomized controlled trial of silymarin treatment in patients with cirrhosis of the liver. J Hepatol. 1989;9:105–113.

Gruenwald J Brendler T et al eds. PDR for Herbal Medicines. Montvale NJ: Medical Economics Company; 1998:1138–1139.

Marshall AW Graul RS Morgan MY Sherlock S. Treatment of alcohol-related liver disease with thioctic acid: a six month radomized double-blind trial. Gut.1982;23:1088–1093.

Mowrey DB. The Scientific Validation of Herbal Medicine. New Canaan Conn: Keats Publishing; 1986:179.

Murray MT Pizzorno JE. Encyclopedia of Natural Medicine. 2nd ed. Rocklin Calif: Prima Publishing; 1998:211–220.

Walker LP Brown EH. The Alternative Pharmacy. Paramus NJ: Prentice Hall; 1998:394.

Wyngaarden JB Smith Jr LH Bennett JC eds. Cecil Textbook of Medicine. 19th ed. Philadelphia Pa: WB Saunders; 1992:786–795.

Copyright © 2000 Integrative Medicine Communications

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application use or misuse of any of the information contained herein including any injury and/or damage to any person or property as a matter of product liability negligence or otherwise. No warranty expressed or implied is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor pharmacist nurse or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage precautions warnings interactions and contraindications before administering any drug herb or supplement discussed herein.