Vitamin E

Nutritional Medicine for cirrhosis

Increase antioxidant intake, to reduce damage to liver cells from free radicals.
The most important antioxidants include –

• Natural 1000 IU daily (some people may need 2000 IU)
• 1000 mg twice daily
• 200 – 300 mcg daily
• To convert from mg to IU: 1 mg of alpha-tocopherol is equivalent to 1.49 IU of the natural form or 2.22 IU of the synthetic form.
• To convert from IU to mg: 1 IU of alpha-tocopherol is equivalent to 0.67 mg of the natural form or 0.45 mg of the synthetic form.
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• Table 1: Recommended Dietary Allowances (RDAs) for Vitamin E (Alpha-Tocopherol) [6]

  Age	Males	Females	Pregnancy	Lactation
  0–6 months*	4 mg (6 IU)	4 mg (6 IU)
  7–12 months*	5 mg (7.5 IU)	5 mg (7.5 IU)
  1–3 years	6 mg (9 IU)	6 mg (9 IU)
  4–8 years	7 mg (10.4 IU)	7 mg (10.4 IU)
  9–13 years	11 mg (16.4 IU)	11 mg (16.4 IU)
  14+ years	15 mg (22.4 IU)	15 mg (22.4 IU)	15 mg (22.4 IU)	19 mg (28.4 IU)

  *Adequate Intake (AI)

• Sources of Vitamin E

  Food
  Numerous foods provide vitamin E. Nuts, seeds, and vegetable oils are among the best sources of alpha-tocopherol, and significant amounts are available in green leafy vegetables and fortified cereals (see Table 2 for a more detailed list) [7]. Most vitamin E in American diets is in the form of gamma-tocopherol from soybean, canola, corn, and other vegetable oils and food products [4].

  Table 2: Selected Food Sources of Vitamin E (Alpha-Tocopherol) [7]

  Food	Milligrams (mg) per serving	Percent DV*
  Wheat germ oil, 1 tablespoon	20.3	100
  Sunflower seeds, dry roasted, 1 ounce	7.4	37
  Almonds, dry roasted, 1 ounce	6.8	34
  Sunflower oil, 1 tablespoon	5.6	28
  Safflower oil, 1 tablespoon	4.6	25
  Hazelnuts, dry roasted, 1 ounce	4.3	22
  Peanut butter, 2 tablespoons	2.9	15
  Peanuts, dry roasted, 1 ounce	2.2	11
  Corn oil, 1 tablespoon	1.9	10
  Spinach, boiled, ½ cup	1.9	10
  Broccoli, chopped, boiled, ½ cup	1.2	6
  Soybean oil, 1 tablespoon	1.1	6
  Kiwifruit, 1 medium	1.1	6
  Mango, sliced, ½ cup	0.7	4
  Tomato, raw, 1 medium	0.7	4
  Spinach, raw, 1 cup	0.6	3

Vitamin E is able to reduce the ability of the stellate cells to manufacture collagen and so reduces scar tissue production. Vitamin E can also soften existing scar tissue and therefore improve blood flow to the liver, which is essential for regeneration of the liver cells. Vitamin E assists in the maintenance of high levels of glutathione, which is the most powerful liver antioxidant to prevent cirrhosis. A clinical study of hepatitis C sufferers not responding to interferon therapy, showed that nearly 50% improved dramatically with 800 IU daily of vitamin E. These are the reasons why a high dose of vitamin E is required. Use only natural vitamin E which is known as d-alpha tocopherol.

It is vital to obtain plenty of beta-carotene and its related carotenoids from eating a wide variety of raw brightly colored fruits and vegetables. Beta-carotene is converted in the body to vitamin A. Beta-carotene, other carotenoids and vitamin A, have a powerful anti-cancer effect in those with cirrhosis. This will reduce the risk of cirrhotic livers developing cancer. Those with liver disease need to be careful not to take excessive amounts of vitamin A and should not take more than 10,000 IU daily.

Selenium has been shown in clinical studies to reduce the incidence of liver cancer and should be taken daily by those with cirrhosis and/or other risk factors for liver cancer. For more information see the websitewww.seleniumresearch.com

Take a that contains the essential nutrients to support the liver’s ability to break down and excrete toxins. This will reduce the damage that toxins can inflict upon liver cells and support the repair of damaged liver cells. For cirrhosis, I would recommend a daily liver tonic that contains Milk Thistle, B vitamins, sulfur containing amino acids and Selenium.

should be taken in a dose of 600mg three times daily to help the damaged liver to make more glutathione.

Vitamin K – many people with cirrhosis have a problem with bruising or bleeding from enlarged veins in the esophagus. This is because the damaged liver cells are unable to manufacture sufficient amounts of clotting factors. This can be helped by the daily consumption of a fresh juice made with a mixture of raw dark green leafy vegetables. Good vegetables to use for this purpose are spinach, kale, beetroot tops, parsley, mint, watercress, wheatgrass and alfalfa sprouts which are high in vitamin K. Vitamin K will help to reduce this deficiency of clotting factors and will reduce bruising and bleeding.

General Measures for cirrhosis

Minimize the use of all medications, especially liver toxins such as alcohol, analgesic drugs (especially acetaminophen, paracetamol and narcotics) and anti- inflammatory drugs. Avoid using household and workplace chemicals such as insecticides, pesticides, chlorine, bleach, paints, glues and solvents.

Protein Intake – the cirrhotic liver cannot handle large amounts of concentrated protein at once time and for this reason minimize the consumption of red meat and poultry. If you eat too much animal protein, ammonia levels will build up in the blood stream causing fatigue and mental confusion. and  supplements help to reduce ammonia levels in the body.  Suitable protein sources are legumes (beans, peas and lentils), grains, cereals, seeds, sprouts and nuts.

Avoid constipation by consuming plenty of raw fruits and vegetables, and grind fresh seeds (flaxseed, pumpkinseed, sunflower seeds etc) and almonds to increase intestinal fiber. powder is excellent to increase necessary fiber bulk in the bowel. This increased fiber will speed the passage of toxins out of the bowels and reduce the ability of these toxins to re-circulate back to the liver. The laxatives Osmolax and Lactulose are also good products to draw fluid into the bowel to ease constipation.

If bowel function is poor because of constipation with high amounts of bacteria in the bowel, this can lead to excessive fermentation of the bowel contents, which will increase absorption of toxic ammonia from the bowel. A healthy liver can convert nitrogen into urea, which is excreted in the urine. In patients with end stage cirrhosis and very poor liver function, the liver is not able to handle these high levels of ammonia and toxic brain symptoms may occur. In this situation bowel function should be improved by increasing raw food fiber and taking supplements of the healthy lactobacillus bacteria. Enemas and colonic irrigations can also help if there is severe constipation and auto-intoxication from the bowel.

Fifty percent of your diet should consist of raw and cooked vegetables and fruits. Dressings can be made with organic apple cider vinegar and cold pressed olive oil. Drink one or two glasses of daily.

Eat cruciferous vegetables including broccoli, cauliflower, Brussels sprouts, kale, cabbage, bok choy and watercress, as well as garlic and onions to help the detoxification ability of the liver.

Ask your doctor to check that your body’s total iron content is within normal limits. This can be confirmed with a simple blood test known as serum iron studies. Excess iron can increase liver damage and cause cirrhosis. If your iron levels are excessively high, avoid iron-enriched cereals, vitamin pills containing iron and liver.