Use
of complementary and alternative medicines (CAM) is increasing among individuals
with liver
disease. The most popular CAM currently in use are herbal therapies. A review
of the efficacy of herbal and other CAM appears in the in press online edition
of Clinical Gastroenterology and Hepatology (January 13, 2007).
The
single most commonly used herbal agent is silymarin, a mixture of the active ingredients
of the milk thistle plant. In animal models, many of the frequently used CAM agents
have shown anti-inflammatory and antifibrotic effects.
According
to the study authors, although many human studies have shown improvements in subjective
symptoms (well being) and liver biochemistry, "there are no convincing data
to suggest a definite histologic and/or virologic improvement with most of these
agents."
"Poorly designed studies, heterogeneous patient populations,
lack of standardized preparations, and poorly defined nonobjective end points
may partly explain the conflicting reports in the literature," write the
authors.
It has been well documented that liver
toxicity and/or unwanted drug interactions may occur form the use of many
herbal medications (e.g., St
John's Wort adverse interaction with HIV
protease inhibitors). The authors urge physicians to talk to their patients
about their potential use of CAM in order to help avoid use of any toxic agents
or those that might cause deleterious drug
interactions.
In addition to silymarin, other CAM reviewed in this
article include herbal medicine 861 (HM861), S-adenosyl-methionine (SAMe), stronger
neo-minophagen C (SNMC), and tumor necrosis factor (TNF).
In conclusion,
the authors write, "Only well-designed, randomized, controlled trials will
be able to ascertain whether CAM has any role in the management of patients with
acute or chronic liver diseases. Until such time, the use of CAM cannot be recommended
as a therapy for patients with liver disease."
Address requests
for reprints to: Paul J. Thuluvath, MD, FRCP, Section of Hepatology, Department
of Medicine, The Johns Hopkins Hospital, 1830 East Monument Street, Room 428,
Baltimore, Maryland 21205; fax: (410) 614-9612.
01/30/07
Reference S
Verma and P J Thuluvath. Complementary and Alternative Medicine in Hepatology:
Review of the Evidence of Efficacy. Clinical Gastroenterology and Hepatology.
In press corrected proof online January 13, 2007.
Selected
Sources of information on SAMe, Silymarin and Tumor Necrosis Factor
SAMe
S-Adenosyl-L-Methionine
for Treatment of Depression, Osteoarthritis, and Liver Disease. Summary, Evidence
Report/Technology Assessment: Number 64. AHRQ Publication No. 02-E033, August
2002. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/epcsums/samesum.htm
SAMe for Depression...and
Arthritis and Liver Support While some of these can cause liver damage, SAMe
has been shown in numerous ... SAMe aids the liver in neutralizing toxins, free
radicals and carcinogens. ... www.cassmd.com/library/SAMe.support.html
