S-adenosylmethionine (SAMe) is a nutraceutical currently being used in a variety of hepatic diseases including chronic hepatitis.
It is an essential molecule in hepatocyte intracellular pathways of drug detoxification, hepatocyte membrane functions and
antioxidation. Without SAMe there can be glutathione depletion and subsequent severe oxidative damage, toxin retention and
free radical accumulation.
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Supplementation with SAMe has the potential to improve hepatocyte function by stimulating cell repair, scavenging free radicals,
suppressing inflammation, improving membrane function and enhancing toxin neutralization. It is given as an enteric-coated
tablet (Denosyl-SD4) at a dosage of 18 mg/kg daily. It is better absorbed in the fasted state. Side effects of this drug are
Milk thistle (Silybum marianum) is an edible herbaceous annual or biennial plant native to warm, dry areas in southern Europe
and northern Africa, and has been used as food in the countries surrounding the Mediterranean. Milk thistle has been used
for liver problems for more than 2,000 years. A group of active ingredients collectively called silymarin (silybinin, isosilybinin,
silychristin and silydianin, etc.) is derived from milk thistle, mainly from the seeds.
Silymarin in the milk thistle extracts is known to protect the liver by strengthening the outer membranes of liver cells,
which prevents toxins from entering the cells. Silymarin also stimulates protein synthesis in liver cells, which helps to
regenerate and repair the liver.
Milk thistle silymarin compounds are also strong antioxidants, and have been shown to reduce damage to liver cells caused
by repeated use of some prescription drugs and may protect liver from cirrhosis, hepatitis and pollutants. Recent studies
have shown that milk thistle extract may also be beneficial for reducing the chance for certain cancers.
With almost no known side effects (milk thistle is a food) and well-known hepatoprotective efficacy, it is said that milk
thistle can't be beat as a liver protector.
Vitamin E therapy is also recommended in chronic hepatitis. Oxidative injury to the liver is now well recognized in several
types of inflammatory processes. Free radicals are generated in chronic hepatitis by the injurious effects of certain drugs,
toxins or immunologic injury. These free radicals can damage cellular macromolecules via lipid peroxidation and thus participate
in cellular injury, and play an important role in initiating and/or perpetuating hepatic injury. Vitamin E reduces oxidant
injury to hepatic tissue by providing protection from free radicals. A water-soluble formulation of Vitamin E is used at a
dosage of 15 units/kg bid.
Dr. Hoskins is owner of DocuTech Services. He is a diplomate of the American College of Veterinary Internal Medicine with
specialities in small animal pediatrics. He can be reached at (225) 955-3252, fax: (214) 242-2200, or e-mail: firstname.lastname@example.org.