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Corrie
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Reged: 07/16/02
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Loc: Southeast US
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I know that there is a wealth of information regarding what supplements we can take to avoid liver problems, as many of us have to take more APAP (tylenol, acetaminophen) than we would like to.
There was a little more information in this article that I had read before, so I thought I would post it.
web page
In particular, there is a segment that states...
Quote:
In addition to pharmaceutical drugs, many people use alternative and complementary therapies for hepatitis. Some find that a combination of conventional and alternative modalities is more effective than any single type of treatment. Herbs often suggested for chronic hepatitis B or C include milk thistle (silymarin), licorice root (glycyrrhizin), bupleurum, phyllanthus, and schisandra. Herbal remedies should be treated like drugs, since they may have side effects and can interact with conventional medications. Many herbs can be toxic to the liver, including chaparral, germander, kava kava, pennyroyal oil, and plants that contain pyrrolizidine alkaloids. Nutritional supplements suggested for hepatitis include vitamin C, vitamin E, selenium, glutathione, N-acetyl-cysteine, alpha lipoic acid, bile acids, coenzyme Q10, lecithin, s-adenosylmethionine (SAM-e), and thymic factors. Some people report that acupuncture helps relieve their symptoms and improve their overall sense of well-being. Inform all your healthcare providers about any herbs, supplements, or other alternative therapies you are using.
I was unaware of the licorice root (glycyrrhizin), bupleurum, phyllanthus, and schisandra. I also didn't realize that chaparral, germander, kava kava (although I did read an article that stated that kava in excess MAY cause liver problems, but I have to wonder just how much) pennyroyal oil, and plants that contain pyrrolizidine alkaloids can be harmful to the liver.
Of course like the article says, I would discuss this with your pharmacist and doctor before you rule them out entirely.
P.S. - sorry if this is redundant information...
Corrie 
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plotinus
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Reged: 09/16/03
Posts: 277
Loc: California
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I think it is valuable information, that needs to be researched either on the web or if nothing is known, then by real researchers. What does concern me is the lumping together of speculative items and known herbs and supplements that can help the liver. For example, NAC and Vitamin C have an extensive research history and in fact APAP over-doses are treated in the ER with pharmaceutical grade NAC. In Germany Standardized Milk Thistle Extract is an accepted treatment for liver damage from alcohol etc. I don't know about the others...
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Corrie
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Reged: 07/16/02
Posts: 362
Loc: Southeast US
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Hi Plotinus,
I agree with you. I've read about NAC and milk thistle, but have yet to read anything about the other supplements mentioned. And if they do help the liver, in what capacity?
Like you said about NAC, or Mucomyst, being used in the emergency room in the reversal of APAP overdosing, there is no other herb used in this fashion in the medical community, or maybe I am missing something?
Anyway, good points.
Corrie
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Tred
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Reged: 10/18/03
Posts: 262
Loc: USA
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One thing I would like to mention about NAC.. It can also produce false readings on liver tests. I was taking a high amount of apap daily for a few months and started to get worried about my liver. The total apap use daily was around 3000mg. Now that's 1000mg under maximum daily limit, but then I realized that 4000mg apap was the maximum for 2-6 weeks at most. A long term level should be under 2800mg apap. Long story short I started taking 1200mg NAC daily for a few months and cut my apap use down to 2500mg. I went in for a liver test (bloodwork) and the results came back horrible. My ALT levels were around 178! I got real scared and thought I screwed up my liver for good, but then got a wierd feeling that the NAC could possibly have caused the ALT levels to show up like that. I scheduled a new liver test for one month later and stopped the NAC completely. One month later I went in and my ALT levels went back to 45. So in the end I don't know if it was just more time that caused the ALT levels to go down or the stopping of the NAC, but either way I do know it can cause liver readings to go out of whack. I think NAC is a great thing to use in overdose situations, but long term uses of it are still unknown.
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TR6
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Reged: 08/27/02
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An important fact I've read in medical literature about NAC is that you must take twice as much Vitamin C along with it - i.e. if you take a gram of NAC, you should take 2 grams of vit C. The statement I read was that NAC can cause more problems than it solves if you don't take the vit C with it -- it has something to do with the byproducts, possibly sulfites, that build up if there isn't enough vit C present (something like that).
I've found that the three best liver supplements are SAM-e, NAC and milk thistle, and using all of these regularly will make a huge difference in stopping and even reversing liver damage from excessive apap intake. I've learned from experience not to casually experiment with exotic herbal remedies -- they can have other components and properties which are often completely unknown and possibly quite dangerous. I've read that Kava can cause serious liver damage over long term. The problem with long-term use of any substance is the potential for buildup of toxic metabolites over time -- demerol is one such drug, which is not supposed to be used long term for that reason.
Edited by TR6 (11/04/03 12:18 PM)
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TR6
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Reged: 08/27/02
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Corrie -- you asked about how these supplements work -- I'll tell you what I have found out about them and maybe others can add additional info. SAM-e is probably the most important supplement. Here's a great link that explains how it works.
http://www.lef.org/magazine/mag97/june-report972.html
NAC is a precursor to glutathione, the nutrient that the liver uses to metabolize APAP. When the liver runs out of glutathione, any additional APAP present in the liver becomes toxic and destroys liver cells, causing necrosis and calcification, basically changing healthy liver tissue into fatty scar tissue. The daily dose of apap that is considered safe is much lower when it is taken over long periods of time -- the danger of using any drug that has even low to moderate levels of potential toxicity increases with the length of time the drug is used.
Milk thistle (silymarin) acts as a liver cleanser. Here is a quote from a government report about it:
Evidence exists that milk thistle may be hepatoprotective through a number of mechanisms: antioxidant activity, toxin blockade at the membrane level, enhanced protein synthesis, antifibriotic activity, and possible anti-inflammatory or immunomodulating effects.
I personally believe that within a few years we are going to see a huge increase in the number of cases of people suffering apap-induced liver disease. People do not take this seriously, we have been so conditioned by marketing hype to believe apap is "safe" that people think they can just take as much as they want. I'm glad to see that you and others are concerned about this subject.
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Corrie
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Reged: 07/16/02
Posts: 362
Loc: Southeast US
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Tred and TR6, thanks SO much for the informative posts and link. I'm going to look it over thoroughly in order to be able to learn a little more about how the liver functions. I already try to adhere to the guidelines regarding how much APAP I injest daily, but I have to be honest and say that there have been times I have gone over the limit, especially when I was taking the 10/500's.
I've since switched back to the Norco's and am tryng just to take them when completely necessary, but I've found that being pain free (or at least as comfortable as possible) has become freeing to me. Also, taking them before the 'big pain' hits works better in regard to pain management (snuffing it out before it gets me). Ya know, like taking the kids to mall excursions and taking step classes at the gym. Stuff I took for granted before and I want to continue to do so badly now.
So I'm really grateful you provided the more detailed information (I've already copied it into my Word document) so I can look back on it when I need to. Like everyone says, we only have one liver. 
Corrie
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