Liver health is vital to patient health. Learn how a variety of Western herbs can be used to support liver function in animals.
As holistic veterinary practitioners, we formulate treatment plans to support the body’s innate ability to heal itself, while also addressing the underlying cause of disease and providing symptomatic relief in our animal patients. The liver is the most important organ of metabolism in the body; supporting liver health supports the body’s ability to heal. This article illustrates how Western herbs support the many different functions of the liver.
A brief review
The liver plays a role in detoxifying molecules, including all the environmental toxins the
body is exposed to. Considering there are somewhere between 25,000 and 84,000 chemicals in commerce in the United States, the liver has a heavy workload.1 Many metabolites are lipid soluble; they must be converted into water-soluble substances by the liver’s detoxification pathways in order to optimize removal. The liver processes these metabolites in two main ways:
- Phase I involves cytochrome p450 enzymes (CYP450) and improves water solubility. The Phase I CYP450 superfamily of enzymes is the first defense to biotransform xenobiotics, steroid hormones, and pharmaceuticals.2 These initial reactions have the potential to create oxidative damage within cell systems because of the resulting formation of reactive electrophilic species.2 The large CYP2 family of enzymes is involved in the metabolism of drugs, xenobiotics, hormones, and other endogenous compounds.2
- Phase II uses conjugation enzymes, Nrf2 signaling, and metallothionein for further biotransformation.2 The collective activity of these enzymes results in an increase in the hydrophilicity of the metabolite, theoretically leading to enhanced excretion in the bile and/or urine.2 Many foods as well as herbs appear to act as both inducers and inhibitors of CYP1 enzymes, an effect which may be dose dependent or altered by the isolation of bioactive compounds derived from food.2 For example, turmeric has been shown in vivo to induce and inhibit CYP1 enzymes.2
What happens in liver disease?
Chronic hepatitis is associated with mixed inflammatory infiltrates and characterized by hepatocellular apoptosis or necrosis, inflammatory infiltrates, regeneration, and fibrosis.3 Mild portal inflammation is seen as a common, nonspecific, reactive change (some internists recommend the pathologist confirms that there is moderate to severe inflammation and necrosis).3 The presence of fibrosis, found through a hepatic biopsy, denotes a more serious consequence.3
Liver cirrhosis is the final phase of all progressive and chronic liver diseases.4 The physiopathology of cirrhosis is determined by multiple factors of varying importance, including oxidative stress, systemic inflammation, and organ dysfunction.4 One of the key elements involved in cirrhosis physiopathology is systemic inflammation, recently described as one of the components in the cirrhosis-associated immune dysfunction syndrome.4 Local injury and inflammation and fibrosis in the liver creates architectural disorganization which impairs bacterial clearance.4 With decreased liver function there is decreased synthesis of innate immune system proteins and pattern recognition receptors that, together, reduce the bactericidal capacity of the cells of the innate immune system.4 As cirrhosis progresses, the gut is affected, in particular the gut-associated lymphoid tissue (GALT), which is the first immunological barrier of defense against antigens and pathogens entering the organism from the intestine. As a consequence of leaky gut, an elevated enteric bacterial load, and changes in intestinal microbiota populations towards pathogenic species, GALT is under the constant pressure of pathological bacterial translocation (BT) and bacterial products translocation.4 Finally, at a systemic level, immune cell function is compromised.4
Based on this very brief review of hepatitis, several classes of herbs should be considered for use (see sidebar) depending upon the needs of the patient. A description of several follows.
- Taraxacum officinale, commonly known as dandelion, has antioxidant properties found to be protective against hepatotoxicity induced by acetaminophen in mice.5,16 Hepatotoxicity induced by acetaminophen is related to reactive oxygen species (ROS) formation and excessive oxidative stress; dandelion root and leaf were found to contain natural antioxidant compounds that diminish the drug-induced hepatic dysfunction.5,6 Dandelion root was found to prevent the increase of serum aspartate and alanine aminotransferases.7 Other studies have shown that dandelion root, as well as dandelion leaf tea (water extract), reduced liver damage serum markers (ALT, AST, GGT, ALP and LDH) thus indicating the plant extract’s effects in restoring the normal functional ability of the hepatocytes.7,8
Centella asiatica (gotu kola) contains asiatic acid, which has been shown in studies to be hepatoprotective, anti-inflammatory, antitumor and neuroprotective. It is also an antioxidant, aids in wound healing, improves microcirculation, and heals inflamed intestinal tissue.9 Additionally, gotu kola inhibited liver fibrosis and largely improved liver function in a dose-dependent manner in rats.9 Liver fibrosis represents the final common pathway of virtually all chronic liver diseases. It is characterized by the excessive accumulation of extracellular matrix (ECM) and activated hepatic stellate cells (HSC) that are undergoing myofibroblast transition identified by de novoa-SMA expression.9 Although significant progress has been made in our understanding of hepatic fibrosis, treatment for liver fibrosis remains ineffective.9 Gotu kola shows potential as a useful herbal option for treatment.
- Andrographis paniculata (green chiretta) is traditionally used for the treatment of the common cold, diarrhea, fever due to infectious causes, jaundice, and cardiovascular health. A health tonic for the liver, it addresses several issues encountered in liver disease due to its antiviral, hepatic anti-inflammatory, antibacterial, antioxidant, hepatoprotective and immunomodulatory properties.10,11 As an immunostimulant, it enhances phagocytic activity.10 As an anti-inflammatory, Andrographis has been found to inhibit COX-2 expression. Energetically, it is a cold and dry plant so is best used to clear the body of heat and to dispel toxins.
- Urtica dioica, better known as stinging nettle, encompasses many actions that are beneficial for liver disease. The leaf is traditionally used for anemia as it supports red blood cell production and capillary and venous integrity. Improving circulation supports blood flow to the healthy areas of the liver and is vital for the patient’s health. The seeds also have antioxidant and hepatoprotective action.12 From an energetic perspective, nettle is generally cool to neutral and slightly dry.13 It is nutritive, supplies minerals, and has the benefit of being a potassium-sparing diuretic, which can be helpful in cases of advanced liver disease with ascites. Nettle assists other organs, including the kidneys, as a tonic, and it enhances the elimination of uric acid and other metabolic wastes.10 Since leaky gut syndrome and dysbiosis often eventually accompany liver disease, the biofilm inhibition abilities of nettle are also beneficial. Many canine patients will readily drink a tea made with nettle leaf.
- Ocimum sanctum, also known as holy basil or tulsi, is a sweet and spicy herb that will help calm a patient with liver disease through its adaptogenic actions. As an adaptogen, it helps with cloudy thinking (which plagues humans with liver disease as well as veterinary patients), in addition to enhancing resistance to the emotional and physiological stresses that accompany chronic disease. It is a nootropic, immunomodulator and anti-inflammatory as well an antioxidant. It provides gastro as well as hepatoprotective effects, beneficial for those patients who have diarrhea and other signs of leaky gut with liver disease.14
- Curcuma longa (turmeric) inhibits hepatic inflammation and upregulates phase II enzymes.15 Beyond its hepatic effects, turmeric stimulates and improves digestion, decreases biofilm production, improves intestinal permeability function, and decreases intestinal inflammation.16,17
Holistic veterinarians address the whole patient and not just the disease. Liver disease in our animal patients is often idiopathic, so it is important to use herbs that are not only hepatoprotective but also exhibit anti-inflammatory and antimicrobial effects, inhibit fibrosis, improve circulation, and protect the gut. A nice generic formulation for liver disease in a patient may include 20% holy basil, 20% gotu kola, 15% Andrographis, 15% dandelion root, 10% turmeric, 10% nettle leaf, 5% licorice and 5% ginger. Herbs are a fantastic choice for veterinarians to use in patients with liver disease, as conventional medicine offers limited treatment options.
1“Roundtable on Environmental Health Sciences, Research, and Medicine; Board on Population Health and Public Health Practice; Institute of Medicine. Identifying and Reducing Environmental Health Risks of Chemicals in Our Society: Workshop Summary”. Washington (DC): National Academies Press (US); 2014 Oct 2. 2, The Challenge: Chemicals in Today’s Society. Available from: ncbi.nlm.nih.gov/books/NBK268889/.
2Hodges, Romilly E, and Deanna M Minich. “Modulation of Metabolic Detoxification Pathways Using Foods and Food-Derived Components: A Scientific Review with Clinical Application.” Journal of nutrition and metabolism vol. 2015 (2015): 760689. doi:10.1155/2015/760689.
3Twedt, David. “Chronic Hepatitis — Latest Update in the Dog”. Atlantic Coast Veterinary Conference 2017, vin.com/members/cms/project/defaultadv1.aspx?id=8207613&pid=19448&meta=vin&.
4Dirchwolf M, Ruf AE. “Role of systemic inflammation in cirrhosis: From pathogenesis to prognosis”. World J Hepatol. 2015;7(16):1974–1981. doi:10.4254/wjh.v7.i16.1974.
5Dirleise Colle, Leticia Priscilla Arantes, Priscila Gubert, Sônia Cristina Almeida da Luz, Margareth Linde Athayde, João Batista Teixeira Rocha, and Félix Alexandre Antunes Soares. “Antioxidant Properties of Taraxacum officinale Leaf Extract Are Involved in the Protective Effect Against Hepatotoxicity Induced by Acetaminophen in Mice”. Journal of Medicinal Food 2012 15:6, 549-556.
6Nazari A, Fanaei H, Dehpour AR, Hassanzadeh G, Jafari M, Salehi M, Mohammadi M. “Chemical composition and hepatoprotective activity of ethanolic root extract of Taraxacum Syriacum Boiss against acetaminophen intoxication in rats”. Bratisl Lek Listy. 2015;116(1):41-6.
7Mahesh A, Jeyachandran R, Cindrella L, Thangadurai D, Veerapur VP, Muralidhara Rao D. “Hepatocurative potential of sesquiterpene lactones of Taraxacum officinale on carbon tetrachloride induced liver toxicity in mice”. Acta Biol Hung. 2010 Jun;61(2):175-90.
8Abdulrahman L. Al-Malki , Mohamed Kamel Abo-Golayel1, Gamal Abo-Elnaga and Hassan Al-Beshri. “Hepatoprotective effect of dandelion (Taraxacum officinale) against induced chronic liver cirrhosis”. Journal of Medicinal Plants Research 2013; 7(20): 1494-1505.
9Li-xia Tang, et al. “Asiatic Acid Inhibits Liver Fibrosis by Blocking TGF-beta/Smad Signaling In Vivo and In Vitro”. PLoS One. 2012;7(2):e31350. doi: 10.1371/journal.pone.0031350.
10David Winston. Herbal Studies Course 2014-2016. Notes.
11Md. Sanower Hossain, Zannat Urbi, Abubakar Sule, K.M. Hafizur Rahman. “Andrographis paniculata (Burm.f.) Wall. Ex Nees: A Review of Ethnobotany, Phytochemistry, and Pharmacology”. 2014. Article ID 274905, 28 pages http://dx.doi.org/10.1155/2014/274905.
12Yener Z, Celik I, Ilhan F, Bal R. “Effects of Urtica dioica L. seed on lipid peroxidation, antioxidants and liver pathology in aflatoxin induced tissue injury in rats”. 2009. Food Chem Toxicol. 47(2):418-24.
13CIVT Veterinary Western Herbal Medicine, Graduate Diploma Class. 2015 Topic Notes.
14Kamyab, A.A., Eshraghian, A. “Anti-Inflammatory, Gastrointestinal and Hepatoprotective Effects of Ocimum sanctum Linn: An Ancient Remedy With New Application”, Inflamm Allergy Drug Targets, 2013 De;12(6):378-84.
15Reuland DJ, Khademi S, Castle CJ, Irwin DC, McCord JM, Miller BF, Hamilton KL. “Upregulation of phase II enzymes through phytochemical activation of Nrf2 protects cardiomyocytes against oxidant stress”. Free Radic Biol Med. 2013 Mar; 56:102-11. Doi: 10.1016/j.freeradbiomed. 2012.11.016. Epub 2012 Nov 30.
16Ghosh SS, He H, Wang J, Korzun W, Yannie PJ, Ghosh S. “Intestine-specific expression of human chimeric intestinal alkaline phosphatase attenuates Western diet-induced barrier dysfunction and glucose intolerance”. Physiol Rep. 2018 Jul;6(14):e13790. doi: 10.14814/phy2.13790.
17Ghosh SS, Bie J, Wang J, Ghosh S. “Oral supplementation with non-absorbable antibiotics or curcumin attenuates western diet-induced atherosclerosis and glucose intolerance in LDLR/mice — role of intestinal permeability and macrophage activation”. PLoS One 9: e108577, 2014. doi:10.1371/journal.pone.0108577.