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

Is kava kava bad or toxic for liver?

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Kava Kava and liver damage or toxicity (hepatotoxicity)

Author: Anil Minocha MD of Shreveport, LA

Kava kava akso known as kava Kava (Piper methysticum) root is widely used for treatment of  anxiety, depression and insomnia. Several reports have implicated in several  severe and even fatal  cases of hepatotoxicity. Immune-allergic mechanisms are believed to be involved in hepatotoxicity.

The regulatory causality evaluation of the reported cases has been mired in debatein the scientific community.  The Food and Drug Adminstration or FDA issued a customer advisory regarding the dangers of this agent in 2002. Its use is banned in several European countries.

Many experts like Anke have challenged  the concept of hepatotoxicity being caused by kava kava in many of the reported cases.  In vitro data does not support a hepatotoxic potential. Many of the effected patients reported in literature were also taking other medications.

Teschke in a thorough review published in Annals of Hepatology (2010) concluded  that kava kava may be hepatotoxic in a few individuals due to overdose, prolonged treatment, co-medication, and probably triggered by an unacceptable quality of the kava raw material. A 6-point program to improve quality by standardization to prevent liver toxicity due to kava has been recommeded.

Citation: Teschke R: Kava hepatotoxicity--a clinical review. Ann Hepatol. 2010;9(3):251-65.

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New hope for fatty liver in overweight, its natural too: L-carnitine

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L-carnitine and fatty liver (NASH, NAFLD) 

Author: Anil Minocha, Shreveport, LA

Nonalcoholic steatohepatitis (NASH) or nonalcoholic fatty liver disease also known as fatty liver is a growing menace especially with the increase in prevalence of metabolic syndrome and obesity. There is paucity of treatments for effective treatment for NAH or fatty liver and many of these patients go on to liver cirrhosis and need liver transplantation. By the way, aA recent study published in the New England Journal of Medicine showed vitamin E to be of benefit.   

Mechanism of action:  L-carnitine adminsteration can affect  multiple metabolic pathways resulting in modifications of lipid profile, and altered glucose metabolism, oxidative stress, and inflammatory reaction. 

 

Authors and study design:  Malaguarnera et al. from the University of Catania, Italy conducted a randomized controlled trial to examine the role of L-carnitine supplementation on reversing the severity of NASH or fatty liver. 

 

Study: Subjects received 1-g L-carnitine tablet after breakfast plus diet and one 1 g tablet after dinner plus diet for 24 weeks or diet alone. Liver tests, as well as levels of  lipids, profile, fasting plasma glucose, C-reactive protein (CRP), tumor necrosis factor (TNF)-alpha, were measured. Histological scores on liver biopsy specimens were also compared.   

 

Study results: As compared to the controls, patients in treatment group demonstrated superior results on aspartate aminotransferase (AST),  alanine aminotransferase (ALT), gamma-glutamyl-transpeptidase (gamma-GT) , total cholesterol,  low-density lipoprotein (LDL) as well as  high-density lipoprotein, triglycerides (P=0.000), fasting glucose,  C-reactive protein (CRP) and tumor necrosis factor-alpha ( TNF-alpha) levels. This was accompanied by a significant improvement in histology scores on liver biopsy.   

Conclusions: L-carnitine administration helps  reduce inflammatory activity as manifested by effect on TNF-alpha and CRP, along with  improvements in liver function, metabolic functions, better lipid profile along with improved liver histology architecture.

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Helicobacter pylori and migraine headache

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Helicobacter pylori infection has been implicated in numerous disorders including vasomotor dysfunction in patients with Raynaud's and cardiovascular disease and may be an uncommon or uusual cause of migraine.

Studies by Hong and colleagues demonstrated that eradication of Helicobacter pylori reduces intensity, duration, and frequency of episodes migraine in patients with Hepatitis B related liver cirrhosis. The authors speculated that H. pylori antigens cause intermittent vasospasm of arterioles thus leading to migraine-type attack and the reduction of these vasoactive substances upon eradication provides protection against migraine attacks.

Gasbarrini and colleagues showed that H. pylori is found in 40% of patients with migraine which is similar to controls. However, among infected subjects, a significantly higher prevalence of the more virulent CagA-positive strains was seen among those complaining of migraine with aura as compared to those suffering from migraine without aura (41% vs. 19%, P<0.01) and with controls (41% vs. 17%, P<0.01).

 Yiannopoulou and colleagues argue that H. pylori infection is a probable independent environmental risk factor for migraine without aura, especially in patients that are not genetically or hormonally susceptible to migraine.

Of note, H. pylori has been implicated in numerous non-gastrointestinal disorders. However, the causal relationship has been difficult to establish in most cases.

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Nutritional supplements for liver disease

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Would you like to know what the renowned experts are saying about nutritional supplements for liver disease patients? 

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. It is superior to placebo for treatment of fatty liver disease. 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.

Carnitine is useful in chronic liver disease especially fatty liver (non-alcoholic faty liver disease or NAFLD or NASH)

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.

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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.

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?

Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger

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.

Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger

Hazards of sharing toothbrush

Although patients with hepatitis C are advised to take care not to share household and personal items such as razors, nail-scissors or toothbrushes with anyone in family, the data to support these recommendations has been scarce.

Dr. Lock and colleagues from the University of Regensburg in Germany addressed this issue in their recent paper titled,"Hepatitis C - contamination of toothbrushes: myth or reality?" This paper was published in the Journal of Viral Hepatology (September 2006).

These investigators recruited thirty consecutive patients with chronic hepatitis C for the study. None of these patients was taking any antiviral medication.

They investigators collected saliva from the patients before and after brushing teeth for 2 minutes. In addition, toothbrush was rinsed after brushing and the rinsing solution was also analyzed.

The saliva before tooth brushing was positive for hepatitis C RNA in 30% of patients. Hepatitis C positive saliva was seen in 37% of patients after brushing. Interestingly, many of these patients had hepatitis C negative saliva before brushing.

Further more, HCV-RNA was seen in 40% of the toothbrush rinsing water specimens. In half of these patients, the saliva before tooth brushing had been negative for hepatitis C.

In conclusion, this study lends further support to the hypothesis that sharing of household items like toothbrushes may represent an unconventional route of hepatitis C transmission. Although some of the earlier studies had shown conflicting results, the difference in the results may be due to the analytical methods used.

Above study notwithstanding, I wonder how many people in general population (with or without hepatitis C) do share toothbrushes. I would like to know your thoughts.

Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger

Coffee protects liver!

Could something contained in coffee be protective against damage to your liver and prevent cirrhosis especially in cases of alcohol related cirrhosis. The results of a recent study by Dr. Klatsky and colleagues from Kaiser Permanente, CA and published in the prestigious journal, Archives of Internal Medicine suggests so.

Liver cirrhosis is a rare disorder and even among people with history of viral hepatitis or alcoholism. The reasons behind why some people are more susceptible than others to develop cirrhosis have been subject of immense speculation. Coffee drinking has been suggested as one of the protective factors and this large epidemiologic study from California lends support to the hypothesis.

The health plan had detailed data on over 12500 persons during a period of 1978-1985. None of them had liver disease at that time. Of those, 330 had developed cirrhosis by the year 2001. Statistical analysis was done to find out the risk factors that contributed to the development of cirrhosis.

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The protection against cirrhosis occurred when people drank at least 1-3 cups per day and the impact was even higher for 4 or more cups of coffee per day. However, the protective effect was limited to alcoholic cirrhosis and no impact was seen for nonalcoholic cirrhosis.

The study did not find any effect of tea on cirrhosis. The protective effect may not be due to caffeine since both tea and coffee contain it. The study suggests there is a component of coffee that protects against cirrhosis.

Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger.