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Nourishing the Liver (repost but good)

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    * Marilyn Sterling, R.D., is a freelance writer, consultant and practicing nutritionist in northern California. Nourishing the Liver By Marilyn Sterling, R.D.
    Message 1 of 1 , Aug 3, 2003
      * Marilyn Sterling, R.D., is a freelance writer, consultant and
      practicing nutritionist in northern California.

      Nourishing the Liver
      By Marilyn Sterling, R.D.

      Is there any way to prevent cirrhosis? Could nutrition help? With
      hundreds of thousands of people at risk, these should be urgent
      public health questions. The only "cure" for cirrhosis is a $400,000
      liver transplant, so finding a way to prevent cirrhosis could save
      many lives, not to mention billions of dollars. Unfortunately,
      society invests most of its health care dollars in treatment rather
      than prevention research. On the bright side, there are some
      intriguing clues about the development of cirrhosis. People who
      already have liver damage, however, have complicated metabolic issues
      and need personalized diet therapy from a registered dietitian. Here
      are some avenues that may help heavy alcohol drinkers or people with
      chronic hepatitis avert cirrhosis development: Limit iron intake
      because hepatitis viruses thrive in iron-rich environments. An iron
      surplus impairs many aspects of immune function including T
      lymphocyte proliferation and maturation. Also, iron catalyzes damage
      byoxidants. While iron deficiency is common among women who
      menstruate, older women and men often have an excess because they
      don't excrete as much. Limiting iron intake weakens hepatitis and
      increases the chance of successful interferon therapy.1 Patients with
      hepatitis C might want to avoid molasses, liver, iron-enriched
      cereals,food cooked in iron pots, multivitamins containing iron, as
      well as limit their intake of meat-all of which contribute excess
      iron. Vitamin C increases iron absorption, so supplements or foods
      high in vitamin C should not be taken with meals. Increase intake of
      choline, an amino acid that is part of the phospholipid lecithin.
      Alcoholism causes a relative choline deficiency in the liver by
      decreasing the enzyme methionine synthetase, which is necessary for
      choline production. A choline deficiency, which promotes liver
      damage, can be corrected with lecithin supplements. Choline
      increases the activity of the enzyme hepatic collagenase, which
      breaks down collagen, preventing cirrhosis. In an experiment on
      primates, baboons were fed high-alcohol diets for eight years. Most
      developed cirrhosis. However, no members of a group provided with
      lecithin supplementation during the experiment developed cirrhosis.
      Large-scale trials are now under way to see if lecithin has the same
      protective effect in humans.2-5 Reduce fat intake. Evidence from one
      study showed this helped hepatitis C patients who drank alcohol.
      Those patients who ate high-fat, low-protein and low-carbohydrate
      diets were more apt to progress to cirrhosis.6 One reason could be
      that unsaturated fatty acids are prone to oxidation, which is
      dangerous to a damaged liver. This might also explain why one animal
      experiment found cirrhosis was reversed in animals consuming
      saturated rather than unsaturated fats(i.e., butter rather than
      sunflower oil). While intriguing because cirrhosis is often
      considered irreversible, no research has been conducted in humans in
      regard to cirrhosis and fat-type consumption. Limiting fat shouldn't
      be taken to extremes,however. People do need to meet their intake
      requirement for essential fatty acids.7 In fact, another experiment
      on monkeys showed that those with diets low in essential fatty acids
      and low in antioxidants were more apt to develop alcoholic

      Take Vitamin E to help maintain high levels of
      glutathione-particularly important for people with hepatitis or other
      liver problems.9,10 Glutathione (GSH), an antioxidant present in the
      liver, is the body's key protector against the oxidizing compounds
      that lead to cirrhosis. By maintaining GSH levels, vitamin E
      supplementation may help protect against cirrhosis. In one study,
      almost 50 percent of people with hepatitis C who did not respond to
      interferon therapy improved dramatically with 800 IU of vitamin E
      daily.11 Just because vitamin E helps protect the liver, however,
      does not mean all antioxidants are equally helpful in liver-related
      problems. Vitamin A, for example, can build to toxic levels in
      damaged livers.12

      Supplement with amino acids such as (SAMe)S-adenosyl-L-methionine and
      N-acetyl cysteine (NAC) to help maintain glutathione. Scientists are
      interested in these amino acids because they may counter the altered
      biochemistry found in patients with liver disease, such as the
      glutathione decrease caused by alcohol and hepatitis.
      S-adenosyl-L-methionine prevented alcohol-induced glutathione
      depletion in a baboon study.13 It is now being tested on humans but
      is quite expensive. In a study of people with hepatitis C, 600 mg
      daily of NAC enhanced the effectiveness of interferon therapy.14
      However, another study did not confirm this finding.15 Regardless,
      NAC protects against damaging oxidant-producing immune factors called
      cytokines and chemokines released in the liver in response to
      heavy-metal exposure.16 Some researchers predict that future
      treatment of hepatitis C will depend on antioxidant therapies such as
      NAC.17 Eat cabbage or any cruciferous vegetable. These can enhance
      the liver's ability to detoxify. Substances that harm the liver act
      synergistically. Alcoholics, for example, are more susceptible than
      nonalcoholics to other liver toxins, and people with hepatitis cannot
      tolerate alcohol. Therefore,it is important for people who are at
      risk of cirrhosis to avoid toxic chemicals and ensure their bodies'
      capacity for detoxification is maximized.

      Here is where the cabbage family shines. The cruciferous vegetables
      activate the liver's cytochrome P450 detoxification chain. Even more
      exciting, researchers have recently found that brussel sprouts
      stimulate the liver's Phase II enzymes-the first dietary component
      shown to affect this important detoxification system. The cruciferous
      vegetable family includes broccoli, cauliflower, kale, mustard
      greens, radish, bok choy and brussel sprouts. Prevention vs. The Cure
      For decades we have accepted that cirrhosis is not preventable, but
      by putting together what we now know about the liver, there is hope.
      Relying on costly, unpleasant interferon and antiviral therapy
      followed by exorbitantly expensive, often unsuccessful liver
      transplants is not a rational way to approach the growing cirrhosis
      epidemic. The focus should be on cost-effective nutrition therapies
      to slow or prevent cirrhosis in the first place.*

      Liver-Friendly Herbs
      In addition to dietary modifications and nutritional supplements,
      there are a variety of herbs with scientific evidence of
      liver-supportive actions. Milk Thistle (Silybum marianum), also
      called St. Mary's thistle or mariana thistle, is the best-known liver
      tonic, having been described in herbals since the late 1600s. Its
      most active constituent, silymarin, is a powerful antioxidant that
      inhibits harmful oxidants and prevents formation of leukotrienes, one
      type of dangerous oxidant produced by the immune system. Silymarin
      not only prevents glutathione depletion but actually increases
      quantities of it.It also has the ability to stimulate protein
      synthesis in the liver.1-3 Artichoke (Cynara scol mus) leaves are
      another liver remedy. Recent animal tests show supplementation with
      artichoke prevented a liver toxin from causing oxidation, thus
      preventing glutathione destruction.4 The active compound, cynarin, is
      found in highest concentrations in the leaves. Chlorogenic acid and
      other antioxidants are also present. Licorice Root(Glycyrrhiza
      glabra), in the form of the injectable active principle glycyrrhizin,
      a saponin glycoside, has been used for liver problems in Japan for 20
      years. Controlled trials have shown that glycyrrhizin use in chronic
      hepatitis is associated with improvement in liver enzymes. Liver
      biopsies confirmed that the liver cells of those taking the compound
      vs. a placebo were healthier.5,6

      Diet for a Healthy Liver
      Certain nutritional factors keep the liver operating smoothly and
      induce detoxification through enzymatic pathways:
      * Garlic, legumes, onions and eggs all (sulfur-rich foods) enhance
      sulfation, which makes toxins easier to excrete.
      * Broccoli, brussel sprouts and cabbage enhance glutathione
      conjugation, a complex process of converting fat-soluble toxins to
      water-soluble ones for easier excretion.
      * Green leafy vegetables rich in folic acid, whole grains and legumes
      rich in vitamin B6, and animal products or supplements providing
      vitamin B12 ensure adequate methylation, which inactivates estrogens
      and increases both bile and lipid flow.
      * Nutritional yeast, whole grains, cabbage, citrus fruits and peppers
      provide the B vitamins and vitamin C necessary for acetylation, which
      helps the body eliminate sulfa drugs.
      * Artichokes, beets, carrots,dandelion and herbs such as cinnamon,
      licorice and turmeric are also useful in maintaining liver health.

      Source: Murray M, Pizzorno J. Encyclopedia of Natural
      Medicine. Rocklin (CA): Prima Publishing; 1998. p 114-23.

      1.Hayashi H, et al. Improvement of serum aminotransferase levels
      after phlebotomy in patients with chronic active hepatitis C and
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      hepatic fibrosis. Compr Ther 1995 Jun;21(6):303-7.
      3.Lieber CS. Alcohol and the liver: 1994 update. Gastroenterology
      1994 Apr;106(4):1085-105.
      4.Chawla RK, et al. Biochemistry and pharmacology of
      S-adenosyl-L-methionine and rationale for its use in liver disease.
      Drugs 1990;40(3 Suppl):98-110.
      5.Cabre E, Gassull MA. Nutritional support in liver disease. Eur J
      Gastroenterol Hepatol 1995;7(6):528-32.
      6.Corrao G, Ferrari PA. Exploring the role of diet in modifying the
      effect of known disease determinants: application to risk factors of
      liver cirrhosis. Am J Epidemiol 1995 Dec 1;142(11):1136-46.
      7.Nanji AA, et al. Dietary saturated fatty acids down-regulate
      cyclooxygenase-2 and tumor necrosis factor alpha and reverse fibrosis
      in alcohol-induced liver disease in the rat. Hepatology 1997
      8.Pawlosky RJ, et al. The effects of low dietary levels of
      polyunsaturates on alcohol-induced liver disease in rhesus monkeys.
      Hepatology 1997 Dec;26(6):1386-92.
      9.Comporti M, et al. Glutathione depletion: its effects on other
      antioxidant systems and hepatocellular damage. Xenobiotica 1991
      10.Houglum K, Venkataramani A. Pilot study of the effects of
      d-alpha-tocopherol on hepatic stellate cell activation in chronic
      hepatitis C. Gastroenterology 1997 Oct;113(4):1069-73.
      11.von Herbay A, et al. Vitamin E improves the aminotransferase
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      double-blind, placebo-controlled study. Free Radical Res 1997
      12.Russell RM. The impact of disease states as a modifying factor for
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      13.Lieber CS. Susceptibility to alcohol-related liver injury. Alcohol
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      14.Beloqui 0, et al. N-acetyl cysteine enhances the response to
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      15.Cimino L. Effect of N-acetyl-cysteine on lymphomonocyte
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      16.Dong W, et al. Toxic metals stimulate inflammatory cytokines in
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      1.Flora K, et al. Milk thistle (Silybum marianum) for the therapy of
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      Toxicol Appl Pharmacol 1997 Jun;144(2):279-86.
      5.van Rossum TG, et al. Review article: glycyrrhizin as a potential
      treatment for chronic hepatitis C. Ailment Pharmacol Ther 1998
      6.Yamamura Y, et al. The relationship between pharmacokinetic
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      8.Takahara T, et al. Effects of glycyrrhizin on hepatitis B surface
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      Marilyn Sterling, R.D., is a freelance writer,
      consultant and practicing nutritionist in

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