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 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


SAM-e (S-adenosyl-L-methionine) for liver disease

Here’s an excerpt from the New York Buyers’ Club guide to using nutritional supplements in the management of liver disease. This entry deals with SAMe, which you’ll also find discussed on this Blog for its use as an anti-depressant. (SAMe is currently the subject of a multi-year National Institutes of Health study of depression at Massachusetts General and Butler Hospitals.)

See also the NYBC entry on SAMe, which explains why it may be a good idea to use this supplement together with vitamins B6, B12, folic acid and, possibly, betaine (TMG).

 S-adenosyl-L-methionine (SAMe). SAMe is an amino acid which helps in the manufacture of the “master antioxidant” glutathione in the liver. It appears to help cell membranes function normally, and assists the liver with detoxification (removal of toxins such as ethanol and pesticides from the system). SAMe can help to normalize bile secretion by the liver, a process commonly affected in chronic liver diseases. Interestingly, in several European studies of people living with hepatitis B or C, it has also been shown to help reduce jaundice, fatigue, and chronic skin irritation and itching, while also lowering liver enzymes and bilirubin levels. Dosages of SAMe in these studies were either 800 mg given intravenously or 800 to 1,600 mg given orally. No significant side effects were reported in any of the studies with SAMe in chronic liver disease.

As SAMe’s mechanism of action in the liver has become better understood by researchers, it’s been used to treat people with alcohol-induced damage to the liver. Basically, SAMe raises levels of the key antioxidant glutathione, which acts in the body to eliminate toxins such as ethanol and other poisons. In this way, SAMe can address cirrhosis and hepatitis stemming from alcohol abuse.

Other recent investigations have suggested that SAMe may play a role in preventing liver cancer, since it seems to have the ability to induce the death of cancerous liver cells. See, for example: Pascale RM, Simile MM, De Miglio MR, Feo F. Chemoprevention of hepatocarcinogenesis: S-adenosyl-L-methionine. Alcohol. 2002 Jul;27(3):193-8.