Supplements for Liver Health

NYBC has published an online guide to Liver Health, which you can access at

SUPPLEMENT No. 17 Summer 2010

Liver Health

And, yes! You’ll find liver healthy supplements like silymarin, alpha lipoic acid and Chinese herbal formulas, all described in detail with usage recommendations in a special section of the NYBC catalog pages:

http://nybcsecure.org/index.php?cPath=57

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Which silymarin/milk thistle?

NYBC has expanded its offerings of the key liver supportive supplement MilkThistle (Silymarin). The Jarrow product, which has good quality control, continues as the standard silymarin offering:

http://nybcsecure.org/product_info.php?cPath=57&products_id=92

We are also stocking Milk Thistle/Silybin Advanced, which is designed for enhanced absorption:

http://nybcsecure.org/product_info.php?cPath=57&products_id=392

And we are stocking the Milk Thistle/Thisilyn Pro product from MMS, which, while more expensive than the others, is produced according to the proverbially exacting standards of the German pharmaceutical industry. Milk thistle being one of the classic items in the German herbal pharmacopoeia, we feel assured that there is extra careful quality control behind this item:

http://nybcsecure.org/product_info.php?cPath=57&products_id=408

As background, we provide NYBC’s capsule summary of how to use silymarin/milk thistle, what cautions should be observed, and what other supplements might be useful along with it:

A potent liver-strengthening herb, it stimulates the liver to regenerate itself by producing new liver cells as well as having strong antioxidant action to help prevent lipid-peroxidation of cell membranes. Given to seven patients receiving tuberculosis drugs (INH and ethambutol), a standardized silymarin extract normalized elevated liver enzymes after three months treatment. Many people with hepatitis C use milk thistle. It is extremely safe. Some studies suggest it may help to reverse the scarring known as fibrosis. Chilean researchers have discovered that silymarin increases glutathione in the liver, stomach and intestines by over 50% although it was not shown to increase GSH levels in other organs. Milk thistle may interact with cytochrome P450–specifically the 3A4 enzyme. This is important since it is used by many AIDS drugs. A study by Piscitelli, et al., happily, found no effect on the plasma level of indinavir (Crixivan). Now we needa study evaluating the potential benefit against the liver toxicities of drugs like nevirapine and ritonavir (Norvir). Anecdotal reports suggest that it may delay CD4 increases with ARV. See also entries on Dandelion Root as well as Hepato-C, Hepato-Detox and Ecliptex (Chinese Herbal Formulae).

Silymarin (milk thistle) for liver support

NYBC provides this description of the botanical Silymarin, also known as milk thistle:

Milk Thistle: Silymarin (Silybum Marianum). A potent liver-strengthening herb, it stimulates the liver to regenerate itself by producing new liver cells as well as having strong antioxidant action to help prevent lipid-peroxidation of cell membranes. Given to seven patients receiving tuberculosis drugs (INH and ethambutol), a standardized silymarin extract normalized elevated liver enzymes after three months treatment. Many people with hepatitis C use milk thistle. It is extremely safe. Some studies suggest it may help to reverse the scarring known as fibrosis. Chilean researchers have discovered that silymarin increases glutathione [a key intracellular antioxidant] in the liver, stomach and intestines by over 50%, although it was not shown to increase glutathione levels in other organs. Milk thistle may interact with cytochrome P450–specifically the 3A4 enzyme. This is important since it is the same pathway used by many AIDS drugs. A study by Piscitelli, et al., happily, found no effect of silymarin on the plasma level of indinavir (Crixivan). Now we need a study evaluating the potential benefit against the liver toxicities of drugs like nevirapine and ritonavir (Norvir). Anecdotal reports suggest that it may delay CD4 increases with ARV.

See also entries on Dandelion Root as well as Hepato-C, Hepato-Detox and Ecliptex (Chinese Herbal Formulas).

Note: NYBC stocks Milk Thistle/Silymarin 80% (Jarrow) [150mg/200 Caps]. Each capsule contains 150 mg of Milk Thistle standardized for 120 mg of Silymarin. This brand has smaller capsules since they do not use a turmeric base. Some find this more convenient to use. PWHIV and PWHCV use 3-6/day.

Suggested Usage: Take 1 to 3 capsules daily, or as directed by your qualified health consultant.

Milk Thistle in Latin is Silybum marianum. This 30:1 concentrate is standardized to contain 80% Silymarin from Milk Thistle seeds.

Silymarin is composed of three flavonoids: primarily Silybin and minor amounts of Silydianin and Silychristin, which support liver function by raising protective glutathione levels.

NEW! Managing and Preventing HIV Med Side-Effects

To mark its fifth anniversary, the New York Buyers’ Club has prepared a special edition of SUPPLEMENT. In it you will find a concise Guide to managing and preventing HIV medication side effects with supplements and other complementary and alternative therapies.

This is an invaluable introduction to how nutritional supplements can be used to counter those side effects that can make life miserable–or even disrupt treatment adherence–in people taking antiretroviral medications for HIV.

Read about approaches to dealing with diarrhea, nausea, heart health issues, diabetes, insomnia, fatigue, liver stress, lipodystrophy, anxiety and depression.

This FREE Guide is available online at:

http://newyorkbuyersclub.org/

On the NYBC website you can also SUBSCRIBE to the nonprofit co-op’s quarterly FREE newsletter, THE SUPPLEMENT, which continues to offer a unique perspective on current evidence-based use of supplements for chronic conditions including cardiovascular disease, diabetes/insulin resistance, hepatitis and other liver conditions, anxiety/depression, osteoarthritis, cognitive and neurorological issues, and gastrointestinal dysfunction.

Many Ways to Love Your Liver

Many Ways to Love Your Liver

(reprinted from the NYBC SUPPLEMENT, Summer 2008)

Liver impairment is a frequent concern for people with HIV. There are many different causes, including co-infection with hepatitis, HIV meds that put added stress on the liver, excessive alcohol or recreational drug use, opportunistic infections, repeated resort to antibiotics, or just consuming big doses of the over-processed, nutrient-poor junk that too often passes for food these days! (By the way, we like the rule of thumb for choosing good stuff at the supermarket: if your grandmother wouldn’t recognize the item as “food”—then it’s probably not very good for you.)

The liver is crucial for processing and breaking down wastes, whether those produced by normal body functioning or those absorbed into the system in the form of drugs, alcohol, or toxins. So keeping it in good repair is essential for health. One specific strategy to support liver function is to maintain levels of the intracellular (= “found within cells”) antioxidant glutathione, which plays a key role in protecting the liver as it performs its detoxification duties. Here is a short list of nutritional supplements that are frequently recommended for this purpose: Vitamin C (2–6 grams per day, in divided doses); N-acetyl-cysteine, or NAC (500 mg, 3 times per day); alpha-lipoic acid (300-600 mg, twice daily). (Note that NAC and Lipoic can be taken in the combination form ThiolNAC, one of the key supplements stocked by NYBC.)

Another worthy option for countering stresses to the liver is an herb called Milk Thistle (Silybum marianum), which has a long tradition of use as a botanical remedy. Modern research has isolated compounds referred to as silymarin within this plant, and many studies have pointed to silymarin’s effectiveness in protecting liver cells from toxic chemicals, and even in stimulating the repair and regeneration of liver cells. In 2007, a federally funded investigation identified one component of milk thistle as a potent anti-cancer agent, and suggested that it held much promise in protecting against or treating liver cancer. Be advised that if you consult sources such as the Canadian AIDS Treatment Information Exchange (CATIE) website, you may encounter concerns about whether silymarin interferes with HIV meds. But here’s what one National Institutes of Health study concluded: “Milk thistle in commonly administered dosages should not interfere with indinavir therapy in patients infected with the human immunodeficiency virus.” This and other research, we believe, suggests that milk thistle-HIV med interference is not actually a very signficant issue.

Now here’s a rather unusual dietary supplement that has been investigated for liver health: S-adenosylmethionine (SAM-e). First isolated by Italian researchers in the 1950s, SAMe is synthesized by living cells from the amino acid methionine and can’t be supplemented from food sources. In several European studies of people living with hepatitis B or C, it has been shown to help reduce jaundice, fatigue, and other symptoms. And it’s also been applied to treating alcohol-related damage to the liver. The unusual aspect of SAMe is that there’s also a great deal of published research on its value as an antidepressant and as a treatment for arthritis—so it’s quite a versatile molecule! (See the NYBC Blog at http://www.nybc.wordpress.com for more details.)

Last, we note that the New York Buyers’ Club, like its predecessor DAAIR, has carefully followed the modern, US-based study and dissemination of traditional Chinese herbal remedies for liver disease. For example, NYBC stocks Pacific Biologic’s Hepato-C and Hepato-Detox, and, more recently, has added Health Concern’s Hepatoplex One and Hepatoplex Two to its product list. Both of these California-based companies have a very good reputation for quality, and both have devised blends based on Traditional Chinese Medicine as well as current clinical experience by licensed practitioners. (Please consult the NYBC website for more information about the specific herbs in these formulas, as well as recommendations for their use.) Of course we’re always interested in hearing about the experience of our members in using these products, and so we welcome your comments and questions—just email us at contact@newyorkbuyersclub.org.

Silymarin/Milk Thistle: University of Washington laboratory study confirms this traditional botanical’s anti-inflammatory, anti-hepatitis C activity, and suggests its usefulness as an adjunct approach in managing chronic hepatitis C

In the May 2007 issue of Gastroenterology, investigators from the University of Washington/Seattle reported on a study of a standardized extract of milk thistle (silymarin), the botanical with a long tradition of use to treat liver disease. They concluded: “The data indicate that silymarin exerts anti-inflammatory and antiviral effects, and suggest that complementary and alternative medicine-based approaches may assist in the management of patients with chronic hepatitis C.”

OK–no big surprising news here. But it’s always nice to see more evidence and more detail about how and why a traditional botanical works effectively!

Citation: SJ Polyak, C Morishima, MC Shuhart, and others. Inhibition of T-cell inflammatory cytokines, hepatocyte NF-kappa B signaling, and HCV infection by standardized silymarin. Gastroenterology 132(5): 1925-1936. May 2007.

Can supplements reduce cancer risk?

Here’s an excerpt from the upcoming issue of the New York Buyers’ Club newsletter, THE SUPPLEMENT.

While it covers some of the same territory on supplements and cancer that we’ve posted earlier on this Blog, it’s valuable as an overview of the question, and balances the news of some notable advances in 2007 with notes and cautions at the end.

—–

Can Supplements Reduce Cancer Risk?

The short answer is: Yes—but please read on for important details!

Last year Memorial Sloan-Kettering Cancer Center (not the least informed organization when it comes to cancer) posted on its website the striking news from a study published in 2007: Vitamin D and calcium supplementation reduces cancer risk. This federally-funded investigation had followed more than a thousand post-menopausal women, some of whom were given calcium + vitamin D3 supplements, some just calcium, and some placebo. When researchers looked at the data, they reached this conclusion: “Improving calcium and vitamin D nutritional status substantially reduces all-cancer risk in postmenopausal women.”

A lot of researchers have been studying Vitamin D3 (the form recommended as most active in the human body) in the last few years, and it’s good to see the scientific findings percolating down to the general public. We were impressed by the lead article on Vitamin D in the February 2008 issue of the University of California, Berkeley’s Wellness Letter (a “newsletter of nutrition, fitness, and self-care”). The Wellness Letter is usually quite conservative on the subject of nutritional supplements, but in this case it found the recent research on Vitamin D persuasive enough to recommend that people “consider taking 800 to 1000 IU of supplemental D a day.” (That’s a higher dose than generally suggested in the past.) As the newsletter reports, there’s a new focus on Vitamin D’s multiple benefits, including its potential to “reduce risk of some common cancers.”

And speaking of getting word out to the general public. Tuning into the Martha Stewart Show not long ago, we saw nutrition and integrative medicine guru Dr. Andrew Weill answering a question from a female audience member by making a strong pitch for regular calcium and Vitamin D3 supplementation, even for younger women. Dr. Weill stressed not only the well-known value against osteoporosis, but also the many new findings on Vitamin D3, such as its role in reducing cancer rates.

But Vitamin D is not the only supplement receiving attention for its anti-cancer properties. A 2007 review of several large prostate cancer prevention studies concluded that several interventions, including dietary supplements such as lycopene, alpha-tocopherol and selenium, have now shown convincing evidence of being able to reduce the risk of this cancer in some circumstances. And the author of this article in the Journal of Urology urged doctors caring for men entering the range of age of prostate cancer risk to inform themselves and their patients about these “preventive opportunities.”

Also in 2007, researchers at the University of California, Irvine, published a study showing that a biologically active component of milk thistle (silymarin) has significant effect against liver cancer cells. Of course milk thistle/silymarin has a long tradition of use as a remedy for liver diseases, and is known to protect the liver from drug or alcohol-related injury. The lead author of this article, who has published extensively on viral hepatitis B and C, cirrhosis, and liver cancer, suggests that the particular component of milk thistle studied (silibinin) could potentially be used to prevent development of liver cancer, one of the most common cancers worldwide.

Notes & cautions: Although research on using supplements to decrease risk of cancer moves forward and has already produced some valuable results, note that there are also many concerns about use of vitamins and other supplements during and following cancer treatment. One problem: supplements may interfere with conventional medications and thus disrupt treatment. Furthermore, it’s important to look at dosage, since some studies have found that “megadoses” of vitamins may be harmful to people with certain cancers. In short, while we are encouraged by studies showing the anti-cancer activity of specific supplements—we’ve highlighted D3, silibinin, selenium, lycopene, and alpha tocopherol—no one should take these findings as a blanket endorsement of any level of supplement use under any circumstance whatsoever!

If you have a question about the usefulness of a supplement as an anti-cancer agent, we recommend the Memorial Sloan-Kettering Integrative Medicine website. This web resource came into being because health professionals recognized the widespread use of supplements by people concerned about their cancer risk or already diagnosed with cancer, and wanted to provide them with evidence-based information to guide their choices. This is also the approach of New York Buyers’ Club: we want to bring up-to-date, scientifically-based information to our members so that they can make good choices about supplement use.