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Supplements to improve liver function - when and how to take them?

In this article:
The role of the liver in the body and the main threats to its health
Liver drugs: what do we need to know?
Liver "cleansing" methods: what works?
Prevent liver disease: advice and recommendations
Supplements to improve liver function - when and how to take them?

Bioactive liver medicines and supplements belong to the pharmacotherapeutic group of hepatoprotectants (from Latin hepar - liver and protecto - to protect). As the name suggests, these products are intended to protect hepatocytes (liver cells) from various destructive factors.

Descriptions of hepatoprotectants state that they can restore the structure of the liver by stimulating the regeneration (rebuilding) of hepatocytes, preventing the destruction of their membranes and improving the functioning of the entire hepatobiliary system, which includes, in addition to the liver, the gallbladder, bile ducts, pancreas and spleen.

However, evidence-based medicine is quite skeptical about the use of some hepatoprotectants. The reason is the lack of research, based on which it could be said with certainty that they really work.

Let's see how we can support liver health and whether dietary supplements are always necessary for this.

The role of the liver in the body and the main threats to its health

As is well known, the liver is the body's main biological "filter" that cleans the blood of many harmful substances. It also participates in the metabolism of micro- and macro-elements, secretes bile, regulates digestion and maintains the body's internal balance.

The liver is an extremely resilient organ with a high capacity for regeneration. However, under certain conditions, even the healthiest liver can be "destroyed" - including by alcohol (especially the "little but often" model) and an unbalanced diet (hello fast food!). The liver can also be damaged, sometimes irreversibly, by hepatitis viruses, diabetes etc.

But there are less obvious reasons why the liver gradually deteriorates. Let's look at each one in turn.

"Dolce vita

For liver health, proper nutrition is extremely important - which means moderation not only in fats and alcohol, but also in sugar. Too much sugar in the diet causes tooth decay, obesity, atherosclerosis and many other serious diseases, including non-alcoholic fatty liver steatosis (NAFLD), which in turn can lead to cirrhosis and liver cancer.

A study by the American Journal of Clinical Nutrition showed that an extra 1000 calories a day from sweets leads to weight gain in only 2% of cases. "But" under these conditions, hepatic steatosis occurs in 27% of cases.

The fat in the liver accumulates primarily under the influence of fructose - a simple carbohydrate of which about half is composed of refined sugar. The highest amounts of 'natural' fructose are found in honey and sweet fruits (bananas, grapes, peaches).

Excess amounts of fructose are also found in sweet carbonated soft drinks and energy drinks. According to research, non-alcoholic liver disease and its serious consequences are more frequently diagnosed in adults and children who consume many such drinks.

Extra pounds

Body positivity has side effects including liver health. Studies have shown that the risk of developing non-alcoholic fatty liver steatosis (NAFLD) is significantly increased in overweight and (especially) obese people. Obese adults suffer from NAFLD very often - according to different studies between 25% and 90% of cases.

Fat deposits on the abdomen

Significant excess fat in the waist area, even if the rest of the body remains relatively slim, is called visceral (abdominal) obesity. Visceral fat accumulates under the abdominal muscles and surrounds the internal organs. This type of fat 'works' like an endocrine organ, significantly altering hormone balance.

Visceral fat is recognized as a key mediator in the development and progression of non-alcoholic fatty liver steatosis (NAFLD) . In addition, the presence of this fat increases the risk of developing other dangerous diseases, including:

  • coronary heart disease;
  • cancer;
  • metabolic syndrome and type 2 diabetes mellitus;
  • asthma;
  • dementia.

Uncontrolled use of medicines and food supplements

Many drugs (hepatotoxic substances) have a negative impact on liver health. Even ordinary medicines have this destructive effect, if they are taken "just for anything" and exceed the recommended dose and/or duration. First and foremost, this applies to the popular analgesic-antipyretic paracetamol (acetaminophen). Taking it frequently and/or for a long time can lead to acute liver failure and even death.

If taken uncontrolled, not only medicines but also food supplements, including vitamins, minerals and vitamin-mineral complexes (VMCs), can be dangerous. "The 'leader' in terms of hepatotoxicity is the fat-soluble vitamin vitamin A (retinol) . In high doses (over 12 000 mcg = 40 000 IU per day), it can damage the liver, causing liver enlargement and cirrhosis.

It is important to remember that dietary supplements and seemingly 'harmless' products - including herbal ones such as green tea, aloe vera, turmeric - can also have hepatotoxic effects. It all depends on the dose and the initial state of the body

Liver drugs: what do we need to know?

Among those unfamiliar with medicine, there is a view that taking hepatoprotectants can protect the liver from almost anything, including the effects of alcohol abuse and unhealthy foods. But is this a correct opinion? To put it bluntly - no, these hopes have little to do with reality. Despite its phenomenal resilience, your liver will not "forgive" you liters of alcohol and pounds of fast food or sweets, even if you combine them with armourarium tablets.

However, hepatoprotectors exist and can be used successfully in certain cases.

Drugs to support liver function and treat the liver are divided into several groups:

  • medicines of plant origin;
  • medicines of animal origin;
  • essential phospholipid (EFL) drugs;
  • certain amino acids and their derivatives;
  • antioxidant vitamins and vitamin-like substances.

The most commonly used, including over-the-counter, are herbal products, including one of the most popular - armurarium (silymarin) .

Now we'll review what is known from an evidence-based medicine standpoint about armurarium and other liver-protective drugs, but let's emphasize one more point:

... herbal dietary supplements are responsible in 20% of cases for liver damage (US statistics). In some cases, they cause liver damage much more severe than the drugs. So be careful!

Armurarium (silymarin)

Armurarium extract contains silymarin - a fairly effective antioxidant, i.e. a substance that theoretically reduces the negative effects of free radicals (oxidative stress) on the liver. What do studies say about this?

In 2003 an experiment was carried out which showed that silymarin can protect liver cells from the destructive effects of alcohol - but this was done "in vitro", on hepatocytes outside the body. In a study in monkeys, silymarin slowed the development of fibrosis (the replacement of liver cells by connective tissue).

Laboratory experiments in mice and cell cultures show that silymarin promotes liver tissue regeneration, reduces inflammation and protects hepatocytes from damage.

However, studies in humans have not yet proven this beneficial effect - the information remains conflicting and awaits more solid confirmation.

In 2007, the Cochrane Collaboration reported that armuraria is ineffective in treating severe liver diseases such as hepatitis and alcoholic liver disease. This is also confirmed by more recent reviews.

According to the optimistic results of one experiment, taking 420 mg of silymarin a day for 2 years helped the survival of people with liver cirrhosis caused by alcohol abuse. However, another study showed less 'rosy' results - taking 450 mg of silymarin a day for 3 years provided no benefit.

So it is not surprising that armuraria is not included in the WHO and FDA recommended lists for the treatment of liver disease. But is it useful to take it 'for prevention'? In principle, no one can prohibit you from doing so - armurarium-based medicines can be bought without a prescription, and in the recommended doses they are safe. However, you should also remember about the side effects of armuraria:

  • risk of allergic reactions in case of allergy to plants of the same family (ragweed, chrysanthemums, daisies, etc.);
  • the risk of lowering blood sugar levels - something to be aware of, especially in type 2 diabetes, where taking sugar-lowering drugs can cause hypoglycemia.

There is also no data on the safety of taking armurarium products during pregnancy and breastfeeding.

Other liver medicines

Here is a brief summary of these medicines, with links to up-to-date studies.

Zinc - may be indicated in alcoholic liver disease as it is often accompanied by zinc deficiency. In alcoholic cirrhosis, 200 mg daily for 1.5 months decreased bilirubin levels and improved blood clotting.

Vitamin E (tocopherol) - may be helpful for the liver if it is not affected by alcohol. Taking 200 mg a day reduced inflammation and fibrosis - but only 22 people took part in the study. Not effective in cirrhosis. Important! Vitamin E is a fat-soluble vitamin (like A, D and K), and its absorption may be reduced in liver damage. Taking tocopherol in doses higher than 268 mg per day increases the risk of death in people with early Parkinson's disease, cardiovascular disorders and coronary heart disease.

Artichoke - an herbal remedy, the second most popular after arrowroot. According to 2016 and 2018 research , it helped reduce markers of liver damage in NAFLD.

Glycyrrhizin from licorice root - an antioxidant that may theoretically reduce inflammation. It has been studied mainly in the treatment of hepatitis C, where it has shown some positive results in patients with interferon intolerance - but the experiments were with very small samples and poor methodologies. Important. It can increase blood pressure, which is dangerous in hypertension, kidney disease and heart failure.

S-adenosylmethionine (SAM-E, ademethionine) - in cirrhosis, daily doses of 1.2-1.6 g improved the condition of patients, and reduced the risk of death and the need for liver transplantation. Important! Not prescribed for anxiety and bipolar disorders, or when taking MAO inhibitors (class of antidepressants). May cause hair color changes, headaches, anxiety, nervousness, insomnia, nausea.

In addition to ademethionine, there are other specific drugs with proven effectiveness - ursodeoxycholic acid (UDCA), L-ornithine-L-aspartate (LOLA). They are prescribed only for strictly defined liver diseases, are not used for prevention and have many contraindications and side effects.

Physicians may prescribe certain drugs for liver protection during prolonged therapy with hepatotoxic drugs (e.g. in the treatment of tuberculosis), as well as as as part of complex therapy for cirrhosis, hepatitis, hyperammonemia, etc.

Liver "cleansing" methods: what works?

Nothing. Moreover, the various methods of "liver cleansing" are extremely harmful and even life-threatening, to which, unfortunately, many non-medically-savvy people resort.

The need for regular liver cleansing is a widespread myth. Moreover, it is often claimed by dishonest manufacturers of various "miracle products". There are also "folk remedies" for this purpose - lemon juice with olive oil, rostopasca, etc.

Why don't they all work? Because the liver does not retain "toxins" that should be "cleansed".

This organ is not a storehouse in which harmful substances accumulate, but rather a biochemical laboratory that processes and neutralizes toxic substances - both those that enter the body from outside and those that form naturally. The remnants of these substances are not retained in the liver - after decomposition, they leave it and are eliminated from the body. Therefore, you should not try to "clean" the liver of what simply does not exist. The liver does not need to be cleansed, because its principle of functioning completely excludes this need

People who perform "liver cleansing/detoxifying" procedures (e.g., with lemon and olive oil and excessive doses of choleretic drugs) describe a black, tar-like substance leaving the body that they consider "toxins" removed from the liver.

In fact, the combination of choleretic drugs with lemon juice and olive oil creates a mixture in the intestine that turns a greenish color due to the presence of bilirubin in the bile. This mixture is considered by the gullible to be 'toxins eliminated from the body'.

Of course, this "cleansing" does not benefit the liver's health at all, but can seriously harm both the liver and the body in general. In particular, if tubing is performed, i.e. if, in addition to oral administration of fats, lemon and choleretic drugs, a warm pillow is applied to the liver area. Why is it dangerous?

  If the person having the 'liver cleanse' has stones in the gallbladder (cholelithiasis), they can migrate and block the bile duct after the procedure. If the person is lucky, they will only have a bout of biliary colic for a few hours after the 'cleanse'. In the worst-case scenario, the result of such "liver care" may be acute cholecystitis, obstruction of the common bile duct, "shutting down" of the gallbladder and eventually its removal (cholecystectomy). And that's if medical help is given as quickly as possible: otherwise, a fatal outcome is possible.

'Cleansing the liver' with rostop also leads to very sad consequences - this herb is highly hepatotoxic. Internal administration of preparations based on rostopască often leads to the development of acute hepatitis. The recovery period after such a "cleansing" can last up to six months or more. In some cases, liver health never recovers.

The World Health Organization (WHO) recommends that the packaging of all products based on rostopas for internal administration should carry a warning that they should only be taken strictly on the advice of a doctor. The hepatotoxicity of rostopas is described in all modern guidelines on hazardous herbs, as well as in hepatology guidelines.

* * *

If symptoms such as nausea, loss of appetite, pain in the right upper quadrant occur, you should first consult a gastroenterologist. The doctor will recommend an ultrasound of the abdominal organs, blood tests (general and biochemical) and other investigations. It is very likely to discover, for example, bile stagnation or stones in the gallbladder. In such cases, the doctor will prescribe the necessary treatment.

If a specific liver disease is diagnosed, appropriate treatment will also be prescribed, which of course will not include any 'cleansing'. As already mentioned, liver diseases do not develop due to the accumulation of harmful substances in the liver - it does not accumulate anything, the mechanism of disease development is different. What is this mechanism?

For example, if the liver has to process too many toxic substances, including alcohol (ethanol), breaking them down into less harmful substances - these breakdown products will damage the mitochondria of liver cells (hepatocytes) over time. As a result, reactive forms of oxygen will accumulate, an energy deficit will occur and inflammation of the liver cells will begin. Under the influence of this inflammation, hepatocytes will begin to die and be replaced by connective tissue (fibrosis). If this process is not stopped in time, cirrhosis will develop. Because the liver "doesn't know" how to announce its problems through pain, cirrhosis is usually diagnosed in advanced stages, when treatment is no longer possible.

The development of non-alcoholic fatty liver steatosis (NAFLD), which we already talked about at the beginning of this article, is also not related to "toxins". It develops due to excessive fat accumulation in the hepatocytes as a result of obesity, metabolic syndrome or type 2 diabetes mellitus.

We therefore advise all our readers not to be swayed by pseudoscientific theories and not to try to 'cleanse' the liver at home. In case of any unusual symptoms or just for preventive purposes, it is better to consult a doctor - therapist, gastroenterologist, hepatologist

Prevent liver disease: advice and recommendations

"Liver cleansing" is unnecessary and dangerous, food supplements have limited effect - how to act to protect and strengthen the liver? Simply do not poison it consciously - and the rest this unique organ will do on its own. Helpful tips:

  • Maintain a normal body weight - BMI (body mass index) calculations for different types of constitutions (asthenic, normotensive, hypersthenic) are helpful here. Avoid fat accumulation around the waist;
  • minimize consumption of alcohol, fat, refined sugar, fructose, sweeteners (many of which are toxic to the liver and kidneys);
  • Eat a healthy and varied diet ('Harvard plate', Nordic or Mediterranean diet), drink plenty of plain water;
  • do not neglect moderate physical activity;
  • do not take medicines or food supplements without consulting a doctor; do not exceed the recommended doses and duration of administration;
  • in the event of any 'alarm signals' from the body in general and the liver in particular - consult a doctor immediately.

Of course, this advice may seem trivial to many, especially in comparison with the advertising of 'miracle liver cleansing products' and other 'magic pills'. However, following these simple recommendations will keep your liver safe for years to come. It is truly a unique organ with a fantastic regenerative capacity. So don't overload it and don't prevent it from doing its job, so that in the future you don't have to take liver medicines prescribed by your doctor.

The Liki24 team wishes you good health and excellent liver tests!

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