The liver is a marvelously sophisticated chemical laboratory, capable of carrying out thousands of chemical transformations on which the body depends. The liver produces some important chemicals from scratch and modifies others to allow the body to use them better. In addition, the liver neutralizes an enormous range of toxins. Without a functioning liver, you cannot live for long.
Unfortunately, a number of influences can severely damage the liver, of which alcohol is the most common. This powerful liver toxin harms the liver in three stages: alcoholic fatty liver, alcoholic hepatitis, then cirrhosis. Although the first two stages of injury are usually reversible, cirrhosis is not. Generally, liver cirrhosis is a result of more than 10 years of heavy alcohol abuse.
Usually, alcoholic hepatitis is discovered through blood tests that detect levels of enzymes released from the liver. The blood levels of these enzymes—known by acronyms such as SGOT, SGPT, ALT, AST, and GGT—rise as damage to the liver (by any cause) progresses.
If blood tests show that you have alcoholic hepatitis (or any other form of liver disease), it is essential that you stop drinking. There is little in the way of specific treatment beyond this.
Several herbs and supplements have shown promise for protecting the liver from alcohol-induced damage. However, none of these has been conclusively proven effective, and cutting down (or eliminating) alcohol consumption is undoubtedly more effective than any other treatment. For information regarding natural treatments that can help people stop drinking, see the article on alcoholism. The alcoholism article also discusses the depletion of certain nutrients, which may affect people who consume enough alcohol to damage the liver.
Below, we concentrate on treatments used specifically to treat early liver damage caused by alcohol. Treatments for more advanced alcohol-induced liver damage are discussed in the liver cirrhosis article.
Numerous double-blind, placebo-controlled studies enrolling a total of several hundred people have evaluated whether the herb milk thistle can successfully counter alcohol-induced liver damage. However, these studies have yielded inconsistent results. For example, a double-blind, placebo-controlled study performed in 1981 followed 106 Finnish soldiers with alcoholic liver disease over a period of 4 weeks.1 The treated group showed a significant decrease in elevated liver enzymes and improvement in liver structure as evaluated by biopsy in 29 subjects.
Two similar studies enrolling a total of approximately 60 people also found benefits.2,3 However, a 3-month, double-blind, placebo-controlled study of 116 people showed little to no additional benefit, perhaps because most participants reduced their alcohol consumption and almost half of them stopped drinking entirely.4 Another study found no benefit in 72 patients who were followed for 15 months.5
A 2007 review of published and unpublished studies on milk thistle as a treatment for liver disease concluded that benefits were seen only in low-quality trials, and, even in those, milk thistle did not show more than a slight benefit.17 A subsequent 2008 review of 19 randomized trials drew a similar conclusion for alcoholic liver disease generally, although it did find a modest reduction in mortality for patients with severe liver cirrhosis.18
For more information, including dosage and safety issues, see the full Milk Thistle article.
High doses of the supplements beta-carotene and vitamin A might cause alcoholic liver disease to develop more rapidly in people who abuse alcohol.14,15 Nutritional supplementation at the standard daily requirement level should not cause a problem. See the articles on Vitamin A and Beta-carotene for more information.
Although one animal study suggests that the herb kava might aid in alcohol withdrawal,16 the herb can cause liver damage; therefore, it should not be used by people with alcoholic liver disease (and probably not by anyone at all). Numerous other herbs possess known or suspected liver-toxic properties, including coltsfoot, comfrey, germander, greater celandine, kombucha, pennyroyal, and various prepackaged Chinese herbal remedies. For this reason, people with alcoholic liver disease should use caution before taking any medicinal herbs.
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2. Feher J, Desk G, Muzes G, et al. Liver protective action of silymarin therapy in chronic alcoholic liver diseases [in Hungarian]. Orv Hetil. 1989;130:2723-2727.
3. Fintelmann V, Albert A. Proof of the therapeutic efficacy of LegalonW for toxic liver illnesses in a double-blind trial [translated from German]. Therapiewoche. 1980;30:5589-5594.
4. Trinchet JC, Coste T, Levy VG, et al. Treatment of alcoholic hepatitis with silymarin. A double-blind comparative study in 116 patients [translated from French]. Gastroenterol Clin Biol. 1989;13:120-124.
5. Bunout D, Hirsch SB, Petermann MT, et al. Controlled study of the effect of silymarin on alcoholic liver disease [translated from Spanish]. Rev Med Chil. 1992;120:1370-1375.
6. McClain CJ, Hill DB, Song Z, et al. S-Adenosylmethionine, cytokines, and alcoholic liver disease. Alcohol. 2002;27:185-192.
7. Abittan CS, Lieber CS. Alcoholic liver disease. Curr Treat Options Gastroenterol. 1999;2:72-80.
8. Rambaldi A, Gluud C. S-adenosyl-L-methionine for alcoholic liver diseases. Cochrane Database Syst Rev. 2001;CD002235.
9. Lieber CS, Casini A, DeCarli LM, et al. S-adenosyl-L-methionine attenuates alcohol-induced liver injury in the baboon. Hepatology. 1990;11:165-172.
10. Barak AJ, Beckenhauer HC, Tuma DJ. Betaine, ethanol and the liver: a review. Alcohol. 1996;13:395-398.
11. Barak AJ, Beckenhauer HC, Junnila M, et al. Dietary betaine promotes generation of hepatic S-adenosylmethionine and protects the liver from ethanol-induced fatty infiltration. Alcohol Clin Exp Res. 1993;17:552-555.
12. Murakami T, Nagamura Y, Hirano K. The recovering effect of betaine on carbon tetrachloride-induced liver injury. J Nutr Sci Vitaminol. 1998;44:249-255.
13. Kanbak G, Inal M, Baycu C. Ethanol-induced hepatotoxicity and protective effect of betaine. Cell Biochem Funct. 2001;19:281-285.
14. Leo MA, Lieber CS. Alcohol, vitamin A, and beta-carotene: adverse interactions, including hepatotoxicity and carcinogenicity. Am J Clin Nutr. 1999;69:1071-1085.
15. Ni R, Leo MA, Zhao J, Lieber CS. Toxicity of beta-carotene and its exacerbation by acetaldehyde in HepG2 cells. Alcohol. 2001;36:281-285.
16. Veh I, Chatterjee SS, Kiianmaa K, et al. Reduction of voluntary ethanol intake in alcohol-preferring AA-rats by kava extract. Presented at International Congress and 49th Meeting of the Society for Medicinal Plant Research; September 2-6, 2001; Erlangen, Germany.
17. Rambaldi A, Jacobs B, Gluud C. Milk thistle for alcoholic and/or hepatitis B or C virus liver diseases. Cochrane Database Syst Rev. 2007;CD003620.
18. Saller R, Brignoli R, Melzer J, et al. An updated systematic review with meta-analysis for the clinical evidence of silymarin. Forsch Komplement Med. 2008;15:9-20.
Last reviewed August 2013 by EBSCO CAM Review Board
Last Updated: 8/22/2013