I recently saw an 81 year old woman with cirrhosis (scarring) of her liver. She had an enlarged and hardened liver and an enlarged spleen (which is a side effect of cirrhosis). She had been observed for 20 years by a doctor because of elevated liver enzymes – but she was told that it was due to a fatty liver and that regular blood testing was the only thing required. Elevated liver enzymes are a sign of liver damage and liver inflammation and this can be treated. Unfortunately for this lovely lady she had been taking numerous drugs even whilst her liver showed signs of ongoing damage. These drugs included cholesterol lowering medications, bisphosphonate drugs for osteoporosis, and a very high dose of the diabetes drug metformin. Thus the treating doctor had assumed that these drugs had no association with her ongoing liver inflammation and had put the raised liver enzymes down to a fatty liver. Now it is true that a fatty liver can lead to cirrhosis, but so can some drugs, so it is always wise to stop drugs which may have liver toxic effects to see if the liver enzymes reduce back to normal. This was never done, nor was a liver biopsy done and she was not referred for a Fibroscan which is a non-invasive test for cirrhosis.
Well luckily for this lady her cirrhosis had not developed to the point of liver failure and she did not yet have ascites (fluid in the abdomen), as her liver was still making adequate amounts of the protein albumin. I think I can help this lady reverse some of her cirrhosis and improve her liver function. I have stopped her cholesterol lowering drug and her bisphosphonate drug and reduced the dose of her diabetes medications to observe the effect on her liver enzymes. Her fatty and scarred liver needs a rest and she will benefit from taking supplements to support her liver function and reduce scarring. She had recently seen a liver specialist – finally !! after years of inadequate treatment and I was so pleased to see that he had prescribed vitamin E – this has been shown to reduce liver scarring. Avocadoes are an excellent source of vitamin E so I asked her to eat them everyday – luckily she loved avocadoes !!
I also prescribed supplements of NAC (N Acetyl Cysteine) in a dose of 600mg three times daily, Selenium 200mcg daily, Vitamin C 1000mg daily and a liver formula. This was to increase the production in her liver of the antioxidant called glutathione, which protects the liver cells from inflammation. To help her osteoporosis I gave her a prescription dose of vitamin D 3 (100,000 IUs) as her blood level of vitamin D was very low. I also tested her to see if she had the genotype which predisposes to gluten intolerance (HLA DQ), as her liver inflammation could have been partly autoimmune in origin.