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Liver Disease and Multivitamins

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In general, taking a multivitamin is a good idea for managing chronic liver disease – but choosing the right one requires awareness of three potential hazards.

A multivitamin is one of the most commonly used nutritional supplement in the U.S., but few realize how valuable it can be for managing chronic liver disease. Taking a multivitamin to help support the liver’s well-being is an obvious choice. However, there are some potential vitamin hazards to avoid. Because they can be instrumental in preventing liver disease progression and complications, living healthfully with chronic liver disease typically involves taking a multivitamin. Nonetheless, those affected will benefit most when they choose their multivitamin wisely.

Cellular Oxidation
Oxidative damage is a frequent cause of liver cell injury, a definitive pathway to the worsening of chronic liver disease. Known as cellular oxidation, this is a natural process where free radicals break down organic tissue.

Without adequate levels of antioxidants in the body, free radicals can damage liver cells. Free radicals can be generated from:

•    normal metabolic processes
•    sunlight
•    pollution
•    toxins
•    stress
•    disease

In someone with chronic liver disease, excessive amounts of free radicals contribute to liver scarring and the liver’s subsequent functional decline. Antioxidants bind with free radicals – neutralizing them so they can’t cause damage to nearby cells. Many common vitamins, like Vitamin A, C and E, are potent antioxidants that prevent cellular oxidation. Hence, multivitamins offer a broad spectrum of free radical fighting antioxidants.

Vitamin D
Another reason for someone with chronic liver disease to take a multivitamin is the supplement’s typical inclusion of Vitamin D. According to researchers from the University of Tennessee in Memphis, over 90 percent of individuals with chronic liver disease have some degree of Vitamin D deficiency. The researchers agreed that severe Vitamin D deficiency was more common among those with cirrhosis – an advanced form of liver disease.

While primarily known for its role in bone health, Vitamin D is also an important nutrient for maintaining cardiovascular, immune and neurological health. According to lead researcher Dr. Satheesh P. Nair, “Since deficiency is common among these patients, Vitamin D replacement may hopefully prevent osteoporosis and other bone complications related to end stage liver disease.”

Liver Detoxification
One of the liver’s principle functions is to detoxify the blood. Many factors play into detoxification, a natural process that may be hampered in those with chronic liver disease. A liver that has sustained significant damage is less able to perform its detoxification duties. This inability to filter toxins leaves a higher concentration of them to accumulate in the liver, a situation that ends up causing even more damage to currently functioning liver cells.

Several ingredients in a good multivitamin will aid the liver in detoxification, such as:

•    Vitamin C
•    Beta Carotene (Vitamin A)
•    Vitamin E
•    B Vitamins

Cautionary Multivitamin Components
When it comes to choosing a multivitamin for someone with chronic liver disease, not all supplements are created equally. The following are important considerations when choosing the right multivitamin:

1.    Vitamin A – Although Vitamin A has several benefits to offer someone with liver concerns, it can be toxic to the liver in high dosages. Experts suggest that those with cirrhosis not take more than 5,000 Units per day. However, Vitamin A as beta-carotene is not toxic to the liver and can be taken in any amount.

2.    Vitamin E – Again, Vitamin E has several benefits to offer someone with liver concerns, but it can be hazardous if taken in excess. In doses over 1,200 IU per day, Vitamin E can thin the blood and cause bleeding.

3.    Iron – Iron may promote the formation of scar tissue in the liver. Therefore, those with chronic liver disease – and especially those with cirrhosis – should take multivitamins without iron unless their physician has determined that they are iron deficient.

A good multivitamin supplies the body with Vitamin D, a wide range of antioxidants and assistance in liver detoxification. However, those with chronic liver disease should be aware of the quantity of Vitamin E, the quantity and form of Vitamin A and the presence or absence of iron. By knowing what to look for and choosing an appropriate multivitamin, managing chronic liver disease will be one step easier.


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http://www.ajcn.org/content/85/1/265S.full, Multivitamin/Mineral Supplements and Prevention of Chronic Disease: Executive Summary, Huang, H-Y, et al, Retrieved June 12, 2011, The American Journal of Clinical Nutrition, January 2007.

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Palmer, Melissa, MD, Doctor Melissa Palmer’s Guide to Hepatitis and Liver Disease, Penguin Group, New York, NY, 2004: pp 392-398.

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About the Author

Nicole Cutler, L.Ac., MTCM, Dipl. Ac. (NCCAOM)®

Nicole Cutler, L.Ac., MTCM is a long time advocate of integrating perspectives on health. With a Bachelor's degree in Neuroscience from the University of Rochester and a Master's degree in Traditional Chinese Medicine from Five Branches Institute, Nicole has been a licensed acupuncturist since 2000. She has gathered acupuncture licenses in the states of California and New York, is a certified specialist with the National Acupuncture Detoxification Association, has earned diplomat status with the National Commission of Chinese and Oriental Medicine in Acupuncture and Chinese Herbology and is a member of the Society for Integrative Oncology. In addition to her acupuncture practice that focuses on stress and pain relief, digestion, immunity and oncology, Nicole contributes to the integration of healthcare by writing articles for professional massage therapists and people living with liver disease.

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