Digestion, health and nutrition: Dr. Anil Minocha, a gastroenterologist and nutritionist

Nutritional supplements for liver disease

Would you like to know what the renowned experts are saying about nutritional supplements for liver disease patients? Below is an update from the recent Clinical Nutrition week (Jan 2007).

Milk Thistle (Silymarin) is a member of daisy family. It has been shown to have beneficial impact in experimental models of chronic liver disease. Evidence suggests that it protects against mushroom poisoning, acetaminophen toxicity and iron overload. It is widely used in Europe. National Institute of Health is conducting trials to examine its efficacy.

Zinc deficiency is seen in chronic liver disease as evident by decreased zinc levels in serum, WBC as well as pancreatic juice in these patients. Zinc therapy improves the abnormal liver enzymes in experimental models of alcoholic liver disease. A dose of 220 mg/d of zinc sulfate has been suggested in such patients.

SAMe is a popular nutritional supplement used for chronic liver disease as well as depression. It has been shown to have beneficial effect on the harmful cytokines associated with liver diseases. A dose of 400 mg four times a day has been suggested.

Vitamin E has recently been gaining a lot of attention. Vitamin E levels in plasma as well as liver are decreased in patients with chronic liver disease. Vitamin E is known to have antioxidant effects and it improves abnormal liver enzymes seen in liver diseases. However, high doses of this vitamin have been shown to be harmful.

Betaine has been studied in NASH. There is good preliminary data suggesting its beneficial effect in chronic liver disease.

Lecithin (polyenylphosphatidylcholine) while effective in preventing alcoholic disease in baboons, has been found to be ineffective in a VA cooperative study (Lieber et al. 2003).

TJ-9 is a combination of several herbs and evidence suggests its beneficial effects in viral liver disease.

Green tea has beneficial impact on the harmful cytokines in mice.

Do you believe in nutrtitional supplements and/or take them for any reason? Please feel free to share your thoughts.

Hepatitis C: another indication for marijuana?

Marijuana has been touted in past for a variety of reasons including its potential use in cancer patients. Now comes a study documenting its benefits for treatment of hepatitis C.

Dr. Sylvestre and colleagues from the University of California in San Francisco studied the effect of symptomatic relief provided by concomitant cannabis use and the outcome of treatment of hepatitis C. They published their findings in the European Journal of Gastroenterology and Hepatology (October 2006).

It was a prospective observational study of standard interferon and ribavirin treatment in 71 recovering substance users, of whom 22 used cannabis.

These investigators found that fewer of cannabis users discontinued therapy (5% versus 33%). On the other hand, cannabis users had a much higher sustained virological response (54% versus 18%).

The authors concluded that modest cannabis use promotes adherence to therapy leading to better symptomatic and virological response.

What are your thoughts about medicinal use of marijuana? Have you tried it for recreational use? What are your thoughts on laws regulating its use especially for terminally ill cancer patients?

Accutane, acne, heart and liver

Physicians frequently use isotretinoin (Accutane®) as a weapon against acne. Previous data has demonstrated that Accutane is associated with birth defects. Now comes a study suggesting that there is also an increased potential for heart and liver problems.

Dr. Zane and colleagues from University of California conducted this retrospective study and published their findings in Archives of Dermatology (August 2006). The study group consisted of 13 772 patients who underwent Accutane® treatment between March 1995 and September 2002. They found a significant increase in serum lipid and liver enzyme (transaminases) levels. However, the liver enzyme abnormalities were mild. Abnormal lab tests in most patients returned to normal when they quit taking the drug.

The authors qualified their conclusions by stating that the clinical significance of these laboratory abnormalities during isotretinoin therapy remains to be determined.

Do you have or had acne? How did it effect you, physically or emotionally? What treatments did you take? Feel free to share your thoughts.