STEP PERSPECTIVE, Volume 7, No. 2 -Summer/1995; A Publication of the Seattle Treatment Exchange Project e-mail: step@eskimo.com
Vic Hernandez, Dr.P.H.

The portal vein drains much of the abdominal organs of blood. Thus products of digestion and metabolism from these organs pass into the liver directly for metabolic processing. These products are processed by the three main types of liver tissues. Hepatic and Kupffer cells provide many of the metabolic transformative functions, while the biliary cells produce bile from digestive nourishment. Kupffer cells remove dead blood cells and microorganisms from circulation, and are important in antibody and bile formation. The hepatic cells perform the majority of the liver's chemicalization functions: processing nutrients from food, transforming blood toxins, metabolizing fat-soluble drugs, and work to facilitate carbohydrate, protein, fat and vitamin metabolism throughout the body.

PWHIVs (people with HIV) may have previous or concurrent liver impairment as a result of injection drug use, hepatitis, alcohol abuse and pharmacological damage from other medications. Because the liver is so important in eliminating infections carried in the blood, low-grade opportunistic infection in PWHIVs constantly pressure the liver to cleanse the blood. Liver stress is also common among HIV+ hemophiliacs. Most people are unaware of liver stress, unless there is liver pain, swelling, symptoms of cirrhosis or, they have blood tests measuring liver function.

Hepatitis is a common form this stress takes. For instance, viral hepatitis has similar transmission vectors as HIV and is seen most often in gay men and intravenous drug users because it is blood-borne. The blood products hemophiliacs infuse may carry many bacterial and viral products from the many donors whose blood is pooled to make clotting factor. Many hemophiliacs have been infected with hepatitis as a result of these pooled blood products in the past. (Currently the risk of hepatitis from blood products is extremely low.) Due to this risk factor, HIV+ hemophiliacs should be aware that liver damage from hepatitis may further impair health. Indeed, hepatitis is the second-most common cause of death among this group of PWHIV.

Caring for the liver is very important for PWHIVs. The metabolic products of HIV and other infections (free radicals, etc.) stress the liver's capacity along with the extra work of processing most medication products a person might be taking. This dual load on the livers shows in elevated enzyme markers in the blood, SGOT and SGPT (laboratory tests that monitor liver function), and may manifest physically as hepatomegaly (enlarged liver) or jaundice (hepatic inability to break down bilirubin with resultant yellowing of skin and eyes). The liver reaches a capacity for handling the toxic effects of disease and medications. This capacity varies from person to person depending upon their medical histories. Not all PWHIV will manifest notable liver stress. Because the liver is important to both blood filtration and drug activities, PWHIV should be aware that relieving stress from the liver will help maintain a more normal physiology during chronic and acute management of HIV disease. This creates a synergistic effect of improving health and normalizes processing of medications.1

Treatment Strategies for Liver Stress

Ingested or injected antibiotics, antivirals, herbal remedies, prophylactic drugs and nutrients pass through the liver where they are processed for excretion or metabolism. Chronic presence in the body of these various substances places a strain on liver function, because liver metabolic pathways can overload, and cannot properly process the onslaught of toxins and metabolites. Poorly processed toxins and metabolites reenter the bloodstream, and consequently can damage other organs and tissues because the liver could not inactivate them or tag them for excretion.

Treatment approaches to HIV/AIDS should revolve around supplementing the liver's processing mechanism and accelerating the transformative processes of hepatic and Kupffer cells handling the increased and chronic drug load. This very simply allows the liver to function as it should, without impairment. More evidence of HIV disease and effects of its management upon liver need to be researched to acquire a more complete picture of liver stress and damage.

There is a long history of herbal hepatic and biliary treatment in western medical history. Most have been tonic, bitter herb medications which promote the flow of bile (cholagogues) and relieve jaundiced conditions. Some of these treatments are chickory, dandelion, wahoo, centaury, mandrake and celandine. Modern pharmaceutical medicine does not provide liver tonics or supportives, and PWHIV's have turned to alternative sources to handle liver stress. Thioctic acid, Silybum marianum (milk thistle), and glycyrrhizin are newer sources of treatment which have proven efficacy in handling liver abnormalities. These treatments are supportive in nature, and affect metabolic pathways in the liver.

Thioctic Acid

Thioctic acid, also known a lipoic acid or alpha-lipoic acid, is a liver protectant nutrient comprised of lipoic acid and fat-soluble thiamine. An essential micronutrient in liver cell metabolic pathways, lipoic acid is rapidly depleted during stress-induced processing. 2,3 People diagnosed with liver cirrhosis, diabetes mellitus, atherosclerosis and polyneuritis have been found to have a reduced level of endogenous lipoic acid. 4,5 Lipoic acid works in catabolic and anabolic pathways with other coenzymes. 6,7 As the liver processes a high toxic load, indicated by elevated liver enzymes in the blood; thioctic acid renders these toxins harmless and opens pathways to accommodate the toxins. Thus liver enzyme levels (SGOT and SGPT) are lowered which reduces strain on the liver that jeopardizes its function. 9 The fat-soluble vitamin thiamine tetrhydrofurfuryl disulfide must be present in complementary amounts to work with and enable lipic acid. 10 Thioctic acid has been used in treatment of alcoholics as a liver protectant. 8,9 Physicians are learning to use it as a therapeutic agent for virally- or drug-induced liver damage, and in the treatment of diabetic neuropathy. 4,5 Additionally, laboratory studies on HIV-infected T-cells treated with thioctic acid showed inhibition of HIV by reducing replication rates of active virus. 10,11

Thioctic acid is manufactured by Cardiovascular Research of Concord, California; and is packaged in capsule form (50 mg/capsule). Supplemental thioctic acid ensures a supply of this micronutrient as the liver demands, and allows efficient processing of blood metabolites. Toxicity has only been documented in animals when fed thioctic acid 1/3(!) of their body weight or more. Two hundred to 250 mg daily is needed to achieve the results desired, lower liver enzyme levels and an easing of stress on the liver. You will observe results (decreases in SGOT and SGPT) within one to two weeks.

Glycyrrhizin

This sulfated polysaccharide from licorice roots has been isolated and prepared by Japanese pharmaceutics for 40 as a treatment for chronic liver disease and stomach ulcer treatment. It is available in tablet and I.V. forms. More recently, Japanese researchers have been evaluating glycyrrhizin in HIV therapy. Glycyrrhizin is a multifactorial medication, it acts upon several different molecular systems in improving health. It is a lectin, and has many binding properties which uniquely protects and supports liver cells, disallowing destructive effects of toxins. These binding properties have recently been shown to clump HIV and other fat-coated microorganisms, where they are scavenged by macrophages, and killed. It inhibits inflammatory processes of all sorts, including hepatitis and allergies, all of which produce destructive oxidants in the blood. Thus, glycyrrhizin prevents formation of oxidants and free radicals. Glycyrrhizin acts as an antiviral, an anti-inflammatory and protectant/preventative medication. 12 For the liver, the reduction of free radical oxidants in the bloodstream relieves the depletion of hepatic glutathione used in reducing these oxidants. Restoring glutathione, especially in the liver where it is a major antioxidant, aids in relieving liver stress. 13

Silybum marianum

Milk thistle (Silybum marianum) is a plant used for centuries as a medicinal agent, known for its abilities to cure jaundice, cleanse the blood and "open up" the liver and gall bladder to proper functioning. It is a common weed in recently abandoned fields, found all across the temperate climates, but originated in western and central Europe. 14 It is available in tincture form, or in tablets where the active agent, silymarin, has been concentrated. It has numerous modes of action on the liver, causing cell regeneration, increasing the vital antioxidant glutathione, increasing tolerance for processing toxins like alcohol, and normalizing drug-induced SGOT and SGPT levels. 15,16,17 Side effects have yet to be uncovered, but since this medicinal has been used for thousands of years without reported untoward effects, therapeutic doses are quite safe.

There are other liver therapies, but these three have significant research and history, as well as anecdotal successes reported by PWHIV. Additionally, they contribute to immune modulation and antiretroviral action, especially glycyrrhizin. 10,12 Thioctic acid and milk thistle are often found in apothecaries and better health food stores. Cardiovascular Research's brand of thioctic acid is formulated with fat-soluble thiamine. You should check other brands to be sure the formulation includes this thiamine derivative. Nutrient-oriented buyer's clubs for PWA's carry all three products; check out Healing Alternatives Foundation in San Francisco(415-626-2316), and DAAIR (212-725-6994) in New York City for supplies and prices; or call the STEP Treatment Hotline to request a listing of various buyers' clubs nationwide.

Vic Hernandez is an HIV/AIDS treatment research consultant.. He is an active member of Direct AIDS Alternative Information Resources (DAAIR) New York City, a non-profit organization formed to support the needs of persons living with HIV/AIDS through the use of natural therapies (particularly nutrients) and minimally toxic drugs.

References

1. Grollman, S. The Human Body: Its Structure and Physiology. Chapter 12 Metabolism: The Liver. 1985 4th Edition New York; MacMillan Publishing Co.

2. Sutherland, I.O., et al. Preparation of (R)-(+) Alpha-Lipoic Acid as Liver Protective Agent. Chemical Abstracts 1986. 109:676.

3. Loginov, A.S., et al. Preparations of Alpha-Lipoic Acid: The Dynamics of Their Content in Blood and Their Effect on Hemostasis in Lesions of the Human Liver. 1990. Pharmacological Toxicology. (Russian) 53(2):47-50.

4. Piering, W.S., and Bratanoaw, N. Clinical Chemistry. 1990. 36:216-221.

5. Altendirch, H., et al. Neurological Teratology. 1990. 12:619-622.

6. McKay, I.R. and Gerswin, M.E. Primary Biliary Cirrhosis: Current Knowledge, Perspective, and Future Directions. Semi Liver Dis 1989 9(2):149-157.

7. Liginov, A.S., et al. Pharmacokinetics of Preparations of Lipic Acid and Their Effect on ATP Synthesis, Process of Microsomal and Cytosol Oxidation in Hepatocytes in Liver Damage in Man. 1989. Pharmacological Toxicology (Russian) 52(4):78-82.

8. Thompson, A.D., et al.

9. Marshal, A.W., et al. Treatment of Alcohol-Related Liver Disease with Thioctic Acid: A Six-Month Randomized Double Blind Trial. Gut 1992. 23:1088-1093.

10. Bauer, A., et al. Alpha-Lipoic Acid is an Effective Inhibitor of Human Immunodeficiency Virus (HIV-1) Replication. Klinische Wochenschrift 1991. 69:722-724m.

11. Grieb, G. Alpha-Lipoic Acid Inhibits HIV Replication. Med-Monatsschr-Pharm 1992. 15(8):243-244.

12. Tochikura, T.S., et al. Antiviral Agents with Activity Against Human Retroviruses. J. Acquired Immune Deficiency Syndrome 1989. 2:441-447.

13. Bingham, F. and Kuebel, M. Glycyrrhizin - A Multifactorial Treatment for HIV. New York, DAAIR, 1993.

14. Grieve, M. A Modern Herbal v.II. p. 797. New York; Dover Publications, 1971.

15. DiMario, F., et al. Die Wirking von Legalon auf die Leberfunctionsproben bei Patienten mit Alcoholbeldinger Leberekrankung, Doppleblindstudie. Der Toxish-Metabolische Lebershaden. pp. 54-58, 1981.

16. Valenzuela, A., et al. Selectivity of Silymarin on the Increase of Glutathione Content in Different Tissues of the Rat. Plant Medica 1989. 55:420-422.

17. Salmi, H.A., and Sarna, S.S. Effect of Silymarin on Chemical Functional, and Morphological Alteration of the Liver. Scandinavian Journal of Gastroenterology 1982. 17:517-521.

Additional References

Culpepper, N. Culpepper's Complete Herbal and English Physician Enlarged. Glenwood IL; Meyerbooks, 1990.

Mowrey, D. Ph.D. New Hope for Liver Health: Milk Thistle. Director Science, Mountain West Institute of Herbal Science. Salt Lake City, Utah.

Shook, E.E. Elementary Treatise in Herbology. Beaumont CA; Trinity Center Press, 1974. Williams, P.L., and Warnick, R., eds. Gray's Anatomy. Edinburgh; Churchill Livingston, 1989.

These articles were provided by the Seattle Treatment Education Project - Copyright (c) 1997 - Seattle Treatment Education Project. Noncommercial reproduction encouraged. Distributed by AEGIS - http://www.aegis.com
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Copyright © 1995 - Seattle Treatment Education Project (STEP) - All rights reserved. Noncommercial reproduction is encouraged. STEP is published four times a year by the Seattle Treatment Education Project, 127 Broadway East, 3rd Floor, Seattle, WA 98102.    Email: step100@aol.com  STEP web page