Use of health supplements

  • Health supplements are part of complementary and alternative medicines (CAM)

  • Use of health supplements in common: up to 20% of patients in U.K. and 65% in Germany uses complementary and alternative medicines (CAM) within one year

  • In one survey in the U.S., up to 39% of patients attending liver disease clinics in the U.S. had used some form of CAM over the prior month.

  • Use of complimentary and alternative medicines is now monitored in Singapore under the Health Sciences Authority and in the U.S. under the National Centre for Complementary and Alternative Medicine (NCCAM) at the Institute of Health.

Origins of CAM

  • Many herbal and complementary medicines use plants or their products as source.

  • Plants have also been the traditional source of many modern and conventional medicines, such as aspirin (for prevention of heart attack), morphine (for pain control), and digoxin (for heart diseases).

  • All prescribed western medicines are under close monitoring and audit by health authorities.

Do herbal medicines or other complementary and alternative medicines work?

  • Although herbal medicines had been around for hundreds or even thousands of years, many herbal medicines are not being regulated, and may not be purified enough and may contain more than one active substances or contaminants.

  • Examples of herbal medicines in liver diseases

    1. Silymarin (milk thistle, hepatofalk ®)

      • Comes from fruits of milk thistle.

      • Had been used as a treatment for liver diseases since the 16th century.

      • May have a protective effects on liver cells, through antioxidant, anti-inflammatory, immnomodulatory, and antifibrotic activities.

      • Some studies showed silymarin can reduce the amount of liver inflammation in patients with chronic Hepatitis C or alcoholic liver diseases.

      • However, some studies showed negative effects. Hence, silymarin cannot be recommended for general use in patients with liver diseases.

      • Fortunately, no adverse effects had been reported in patients taking silymarin.

    2. Phyllanthus species

      • A plant product

      • Some studies showed its effects in suppressing Hepatitis B virus replication, and some studies also showed it may help clear Hepatitis B virus and help normalize inflammation in patients with active Hepatitis B.

      • But the design and conduct of these preliminary studies were poor.

      • One recent good study from the Chinese University of Hong Kong whereby 80 Chinese with active Hepatitis were randomized into taking Phyllanthus products or placebo, and this study showed that Phyllanthus had no effects on virus replication or liver inflammation.

Are all herbal medicines and CAM safe?

  • Contrary to the widespread view that because CAM are natural, and therefore safe, herbal therapy may be associated with serious adverse effects to the liver or the other organs and systems

  • Main reason for that is that CAM are not officially regulated by health authorities and hence, no proper studies are performed and hence, their adverse effects are not known or monitored.

  • Adverse effects of CAM:

    1. Direct adverse effects and toxicity on liver

      • Some herbal medicines such as common herbal tea, kava, chapparal, and germander, had been associated with serious liver injury

    2. Herb-drug interaction

      • As proper studies on CAM are rare, many potential interaction with drugs that patients are already taking may not be known.

      • Ginseng and garlic are known to potentiate the effects of warfarin (a blood thinning drug) leading to excessive bleeding.

      • Tamarind is been known to potentiate the effects of aspirin leading to excessive bleeding.

      • St. John's wort is known to reduce the effects of cyclosporin (a drug that prevents rejection after organ transplant) leading to organ rejection.

    3. Indirect adverse effects

      • In addition, some patients who initially consult herbal practitioners may suffer from misdiagnosis and delay in obtaining effective conventional treatment.

      • Others may forgo taking appropriate conventional medical advice while taking herbal medicines.

I have liver disease, so do I need any more supplements?

In general, there is no need to take any supplements for patients with liver disease, but feel free to discuss with your liver doctor when you have queiries.

5 Cs to a health liver

  • Cover yourself from preventable liver diseases.

  • Caution yourself against harmful substances.

  • Consume well balanced diet.

  • Comprehend the common symptoms of a liver problem.

  • Consult your doctor when in doubt and for monitoring your liver condition!