Priority 15 from the Alcohol-related Liver Disease PSP

UNCERTAINTY: What dietary recommendations or supplements (including herbal and vitamins) are beneficial in patients at risk of or with established alcohol-related liver disease? (JLA PSP Priority 15)
Overall ranking 15
JLA question ID 0044/15
Explanatory note (including examples of original survey submissions) This question covers a number of issues. It is important for a person to feel that they have some control over their condition and therefore, apart from stopping alcohol consumption, are there certain things they should or should not eat in order to help the liver cope and recover. A much greater understanding is developing over the last few years of how specific dietary constituents may affect the gut and thereby potentially affect the liver. It was felt that this area required further research as well as whether specific dietary supplements could help this condition. The importance of diet as an aid to recovery from ARLD is a recurring theme: "What is the optimum nutritional diet for those with alcohol-related liver disease and how should it vary by stage/symptoms?  .... there appears to be no general acceptance of best practice across clinicians and dieticians" "What is the correct amount of vitamins to give to patients when presenting in alcohol withdrawal?"     "Are there any vitamins that it would be worth taking and any to avoid?"   The use of dietary supplements, particularly milk thistle, is also of interest to many  "Is milk thistle (Silybum marianum) beneficial to the liver?"

Systematic reviews:

Salameh H., Bonkovsky H., Kuo Y.-F., Singal A. Impact of nutritional supplementation in patients with alcoholic cirrhosis and alcoholic hepatitis: A meta-analysis of randomized placebo controlled trials. Am J Gastroenterol 2013:108;S133. doi:10.1038/ajg.2013.265. 

Fialla A.D., Israelsen M., Hamberg O., Krag A., Gluud L.L. Nutritional therapy in cirrhosis or alcoholic hepatitis: A systematic review and meta-analysis. Liver Int 2015:35(9);2072-8. doi: 10.1111/liv.12798.

Antar R, Wong P, Ghali P.  A meta-analysis of nutritional supplementation for management of hospitalized alcoholic hepatitis. Can J Gastroenterol 2012:26(7);463-7.

Health Research Classification System category Oral and Gastrointestinnal
Extra information provided by this PSP
Submitted by 10 patients, 4 carers and 14 professionals