Herbal Treatments for Non-alcoholic fatty liver disease (NAFLD)
By Renata Trister DO
Non-alcoholic fatty liver disease (NAFLD) is one of the leading causes of chronic liver injury. There is also strong association to other conditions, such as obesity, diabetes, cardiovascular diseases, and metabolic syndrome. The exact pathology of NAFLD is not fully understood, but seems connected to insulin resistance, lipid metabolism dysfunction, oxidative stress, and inflammation. NAFLD is one of the leading causes of chronic liver disease in both developed and developing countries. Although it is considered a somewhat benign form of chronic liver injury, without proper treatment and lifestyle modifications, about 20% of NAFLD patients can advance to cirrhosis and liver cancer. Recently, the use of herbal treatments for NAFLD has received attention due to their low side effects, and proven therapeutic benefits. The use of wolfberry, garlic, resveratrol (from grape seeds), and milk thistle seem to be most promising.
Lycii fructus (wolfberry, goji berry)
Wolfberry or goji berry is the fruit of plant Lycium barbarum of the family Solanaceae. These berries have been used in traditional Chinese medicine for centuries to support the liver and the eyes. The polysaccharide in the goji/wolfberry (often referred as LBP) appears to be the most active portion. Studies show that LBP has many effects, including antioxidant effect, immunoregulation, neuroprotection, control of glucose metabolism, and anti-tumor activity. Clinical trials also found that intake of goji berry juice increases the number of lymphocytes and levels of interleukin-2 and immunoglobulin G. LBP also was found to increase the serum levels of antioxidants. In the liver, studies show that treatment with LBP inhibited proliferation and induced apoptosis in hepatoma cells, suggesting possible anti-tumor activity of LBP.
Garlic, or Allium sativum, is a species in the onion genus Allium. It has a very long history (over 6,000 years) in culinary and medicinal uses all over the world. A recent paper reported a liver protective effect of dietary consumption of fresh garlic. Garlic attenuates abnormal lipid profile through AMP-activated protein kinase (AMPK) pathway. The use of raw garlic along with the diet modifications improves insulin resistance, oxidative stress, and lipid metabolism.
Resveratrol is a substance extracted from red grapes. It is one of the most well-documented and accepted herbal medications in the world due to its tremendous effect against oxidation and inflammation. In recent years, many groups have found the very promising phytochemical properties of resveratrol in the treatment of NAFLD. Treatment with resveratrol can lead to the suppression of lipogenic genes in the liver. This effect was further supported by the studies in which treatment with resveratrol diminished oxidative stress and inflammation.
Silymarin is a derivative of plant milk thistle (Silybum marianum). Thousands of papers have been published on the antioxidative, and hepatoprotective effects of silymarin. In the liver cells, the beneficial effects of silymarin include antioxidative effects, direct/indirect effects on inflammation and fibrosis, as well as modulation of metabolic pathways. The anti-inflammatory effects of silymarin are due to its interference with NF-κB–controlled transduction cascade. A recent basic study showed that crude extract of Silybum marianum has a powerful anti-inflammatory role in the treatment of steatohepatitis.
The pathology of NAFLD is very complex and not yet understood. It is attributed to multiple events, from insulin resistance to apoptosis. Goji berry derived LBP, garlic, resveratrol, and milk thistle are the most promising herbal remedies that can target some of the pathological changes of NAFLD development.