Alcoholic beverages present a perfect example of the ancient virtue of moderation. While small amounts of alcohol (the equivalent of one to two drinks daily) may actually enhance health,44 excessive consumption of alcohol wreaks gradual havoc throughout the entire body. The liver is often the first organ to show injury, followed by (in no set order) the brain, circulatory system, pancreas, stomach, and throat.
Conventional treatment of alcoholism involves nutritional support and various means to induce and maintain abstinence. Alcoholics Anonymous is the most effective known abstinence-promoting method, but other programs and techniques are also in use. The drugs acamprosate (Campral) and naltrexone (ReVia) have shown considerable promise. It is not clear whether disulfiram (Antabuse) actually offers any benefit.
Principal Proposed Natural Treatments
The herb milk thistle and the supplement SAMe have been recommended for protecting the liver from alcohol-induced damage. However, neither of these has been conclusively proven effective; abstinence is undoubtedly more effective than any treatment. For additional information, see the articles on Alcoholic Hepatitis and Cirrhosis.
In addition to damaging the liver, alcoholism causes a general depletion of nutrients. People who drink to excess (either because they have not quit drinking or because they are in the process of quitting) may benefit from supplementation.
Numerous double-blind, placebo-controlled studies enrolling a total of several hundred participants have evaluated whether milk thistle can successfully counter alcohol-induced liver damage.1-11 Unfortunately, most of the studies were flawed in design and reporting, and their results were less than consistent. A 2007 review of published and unpublished studies on milk thistle as a treatment for liver disease concluded that benefits were seen only in low-quality trials, and, even in those, milk thistle did not show more than a slight benefit.45 A subsequent 2008 review of 19 randomized trials drew a similar conclusion for alcoholic liver disease generally, although it did find a modest reduction in mortality for patients with severe liver cirrhosis.46
At present, therefore, it is not possible to draw firm conclusions about milk thistle’s usefulness for people who overconsume alcohol. For more information, see the full Milk Thistle article.
The supplement S-adenosylmethionine (SAMe) has been proposed for the treatment of alcoholic liver disease, but there is as yet no meaningful evidence that it is effective.12 A 2-year, double-blind, placebo-controlled study of 117 people with alcoholic liver cirrhosis found that treatment with SAMe reduced mortality and/or the need for a liver transplant in those with less advanced disease, but not in the group as a whole.13 For more information, see the full SAMe article.
Nutritional Support TOP
Chronic overconsumption of alcohol may lead to improper metabolism or outright deficiencies of numerous vitamins and minerals.34 For this reason, use of a general nutritional supplement may be advisable. (See, however, the warning regarding beta-carotene and vitamin A in the section on Herbs and Supplements to Avoid.)
Other Proposed Natural Treatments TOP
In a double-blind study of 64 people, use of an extract made from the skin of the fruit of the prickly pear cactus Opuntia ficus indica significantly reduced hangover symptoms as compared to placebo.38 The greatest improvements were seen in symptoms of nausea, loss of appetite, and dry mouth. Overall, the rate of severe hangover symptoms was 50% lower in the treatment group as compared to the placebo. The researchers involved in this study hypothesized that hangovers are caused by inflammation and that the herb reduced inflammation.
Artichoke leaf is much better known than prickly pear cactus as a means of preventing hangover symptoms. However, the one double-blind study on the subject failed to find artichoke any more effective than placebo.39
The supplement trimethylglycine (TMG) stimulates the formation of SAMe and might be helpful for alcoholic liver disease.14-17 However, no meaningful double-blind, placebo-controlled clinical trials have been reported.
The supplement phosphatidylcholine has been advocated as a treatment for early alcohol-related liver damage (especially fatty liver), but the results of highly preliminary studies have been inconsistent.18-22 One study in baboons even found evidence of increased liver toxicity.19
Other herbs and supplements that have been proposed for protecting the liver, but only on the basis of extremely weak evidence, include andrographis, barberry, beet leaf, boldo, dandelion, inositol, licorice, lipoic acid, liver extracts, N-acetylcysteine, Picrorhiza kurroa, schisandra, taurine, thymus extract, and turmeric.
The herb kudzu has been widely advocated as an aid for quitting alcohol, based on studies using hamsters or rats.23 However, small, double-blind studies in humans have yielded inconsistent results at best .24,41
Acupuncture has also been proposed as an aid to alcohol withdrawal. However, study results have been contradictory, and the largest trial failed to find any benefit. This 3-week, single-blind trial study of 503 alcoholics failed to find any difference between real ear acupuncture and placebo ear acupuncture.25 In addition, a 10-week, single-blind, placebo-controlled study of 72 alcoholics found no difference in drinking patterns or cravings between sham acupuncture and real acupuncture groups.26 Negative results were also seen in a similar trial of 56 participants,27 and in one of 48 people.40 A study of 109 people compared acupuncture against aromatherapy (intended by these researchers as a placebo) and failed to find that acupuncture was more effective.43 However, a single-blind trial of 54 people did find acupuncture more effective than a placebo,28 as did a single-blind trial of 80 people.29
One study suggests that honey consumption might increase the body's ability to metabolize alcohol, thereby limiting intoxication and more rapidly reducing blood alcohol levels down to a safer (or legal) zone.20
Herbs and Supplements to Avoid TOP
High doses of the supplements beta-carotene and vitamin A might cause alcoholic liver disease to develop more rapidly in people who abuse alcohol.31,32 Nutritional supplementation at the standard daily requirement level should not cause a problem. See the articles on Vitamin A and Beta-carotene for more information.
All forms of vitamin B3, including niacin, niacinamide (nicotinamide), and inositol hexaniacinate, may damage the liver when taken in high doses. (Again, nutritional supplementation at the standard daily requirement level should not cause a problem.)
One animal study suggests that the herb kava may have value as an aid to alcohol withdrawal.33 However, people who abuse alcohol should probably not take kava at all; even in healthy people, the herb has caused severe liver damage.
Numerous herbs and supplements have known or suspected liver-toxic properties, including, but not limited to, barberry, borage, chaparral, coltsfoot, comfrey, germander, germanium (a mineral), greater celandine, kombucha, mistletoe, noni, pennyroyal, pokeroot, sassafras, and various herbs and minerals used in traditional Chinese herbal medicine. In addition, herbs that are not liver-toxic in themselves are sometimes adulterated with other herbs of similar appearance accidentally harvested in a misapprehension of their identity (for example, germander found in skullcap products). Other forms of contamination are possible as well. Blue-green algae species, such as spirulina, may at times be contaminated with liver-toxic substances called microcystins (for which no highest safe level is known).
Some articles claim that the herb echinacea is potentially liver-toxic, but this concern appears to have been based on a misunderstanding of its constituents. (Echinacea contains substances in the pyrrolizidine alkaloid family. However, while many pyrrolizidine alkaloids are liver toxic, those found in echinacea are not believed to have that property.)
Whole valerian contains liver-toxic substances called valepotriates. However, valepotriates are thought to be absent from most commercial valerian products,35 and case reports suggest that even very high doses of valerian do not harm the liver.36,37
References[ + ]
1. Salmi HA, Sarna S. Effect of silymarin on chemical, functional and morphological alterations of the liver. A double-blind controlled study. Scand J Gastroenterol. 1982;17:517-521.
2. Feher J, Desk G, Muzes G, et al. Liver protective action of silymarin therapy in chronic alcoholic liver diseases [in Hungarian]. Orv Hetil. 1989;130:2723-2727.
3. Fintelmann V, Albert A. Proof of the therapeutic efficacy of LegalonW for toxic liver illnesses in a double-blind trial [translated from German]. Therapiewoche. 1980;30:5589-5594.
4. Trinchet JC, Coste T, Levy VG, et al. Treatment of alcoholic hepatitis with silymarin. A double-blind comparative study in 116 patients [translated from French]. Gastroenterol Clin Biol. 1989;13:120-124.
5. Bunout D, Hirsch SB, Petermann MT, et al. Controlled study of the effect of silymarin on alcoholic liver disease [translated from Spanish]. Rev Med Chil. 1992;120:1370-1375.
6. Ferenci P, Dragosics B, Dittrich H, et al. Randomized controlled trial of silymarin treatment in patients with cirrhosis of the liver. J Hepatol. 1989;9:105-113.
7. Benda L, Dittrich H, Ferenzi P, et al. The influence of therapy with silymarin on the survival rate of patients with liver cirrhosis [translated from German]. Wien Klin Wochenschr. 1980;92:678-683.
8. Pares A, Planas R, Torres M, et al. Effects of silymarin in alcoholic patients with cirrhosis of the liver: results of a controlled, double-blind, randomized and multicenter trial. J Hepatol. 1998;28:615-621.
9. Lang I, et al. Hepatoprotective and immunological effects of antioxidant drugs. Tokai J Exp Clin Med. 1990;15:123-127.
10. Lang I, et al. Immunomodulatory and hepatoprotective effects of in vivo treatment with free radical scavengers. Ital J Gastroenterol. 1990;22:283-287.
11. Lucena MI, Andrade RJ, de la Cruz JP, et al. Effects of silymarin MZ-80 on oxidative stress in patients with alcoholic cirrhosis. Results of a randomized, double-blind, placebo-controlled clinical study. Int J Clin Pharmacol Ther. 2002;40:2-8.
12. Rambaldi A, Gluud C. S-adenosyl-L-methionine for alcoholic liver diseases. Cochrane Database Syst Rev. 2001;CD002235.
13. Mato JM, Camara J, Fernandez de Paz J, et al. S-adenosylmethionine in alcoholic cirrhosis: a randomized, placebo-controlled, double-blind, multicenter clinical trial. J Hepatol. 1999;30:1081-1089.
14. Barak AJ, Beckenhauer HC, Tuma DJ. Betaine, ethanol and the liver: a review. Alcohol. 1996;13:395-398.
15. Barak AJ, Beckenhauer HC, Junnila M, et al. Dietary betaine promotes generation of hepatic S-adenosylmethionine and protects the liver from ethanol-induced fatty infiltration. Alcohol Clin Exp Res. 1993;17:552-555.
16. Murakami T, Nagamura Y, Hirano K. The recovering effect of betaine on carbon tetrachloride-induced liver injury. J Nutr Sci Vitaminol. 1998;44:249-255.
17. Kanbak G, Inal M, Baycu C. Ethanol-induced hepatotoxicity and protective effect of betaine. Cell Biochem Funct. 2001;19:281-285.
18. Lieber CS, DeCarli LM, Mak KM, et al. Attenuation of alcohol-induced hepatic fibrosis by polyunsaturated lecithin. Hepatology. 1990;12:1390-1398.
19. Lieber CS, Leo MA, Mak KM, et al. Choline fails to prevent liver fibrosis in ethanol-fed baboons but causes toxicity. Hepatology. 1985;5:561-572.
20. Lieber CS, Rubin E. Alcoholic fatty liver. N Engl J Med. 1969;280:705-708.
21. Schuller-Perez A, Gonzalez San Martin F. A controlled study with polyunsaturated phosphatidylcholine compared to placebo in alcoholic steatosis of the liver [translated from German]. Med Welt. 1985;36:517-521.
22. Knuchel F. Double-blind study in patients with alcoholic toxic fatty liver. Effect of essential phospholipids on enzyme behavior and lipid composition of the serum [translated from German]. Med Welt. 1979;30:411-416.
23. Keung WM, Vallee BL. Kudzu root: an ancient Chinese source of modern antidipsotropic agents. Phytochemistry. 1998;47:499-506.
24. Shebek J, Rindone JP. A pilot study exploring the effect of kudzu root on the drinking habits of patients with chronic alcoholism. J Altern Complement Med. 2000;6:45-48.
25. Bullock ML, Kiresuk TJ, Sherman RE, et al. A large, randomized, placebo-controlled study of auricular acupuncture for alcohol dependence. J Subst Abuse Treat. 2002;22:71-77.
26. Sapir-Weise R, Berglund M, Frank A, et al. Acupuncture in alcoholism treatment: a randomized out-patient study. Alcohol Alcohol. 1999;34:629-635.
27. Worner TM, Zeller B, Schwarz H, et al. Acupuncture fails to improve treatment outcome in alcoholics. Drug Alcohol Depend. 1992;30:169-173.
28. Bullock ML, Umen AJ, Culliton PD, et al. Acupuncture treatment of alcoholic recidivism: a pilot study. Alcohol Clin Exp Res. 1987;11:292-295.
29. Bullock ML, Culliton PD, Olander RT. Controlled trial of acupuncture for severe recidivist alcoholism. Lancet. 1989;1:1435-1439.
30. Akhondzadeh S, Kashani L, Mobaseri M, et al. Passionflower in the treatment of opiates withdrawal: a double-blind randomized controlled trial. J Clin Pharm Ther. 2001;26:369-373.
31. Leo MA, Lieber CS. Alcohol, vitamin A, and beta-carotene: adverse interactions, including hepatotoxicity and carcinogenicity. Am J Clin Nutr. 1999;69:1071-1085.
32. Ni R, Leo MA, Zhao J, et al. Toxicity of beta-carotene and its exacerbation by acetaldehyde in HepG2 cells. Alcohol. 2001;36:281-285.
33. Veh I, Chatterjee SS, Kiianmaa K, et al. Reduction of voluntary ethanol intake in alcohol-preferring AA-rats by kava extract. Presented at: International Congress and 49th Meeting of the Society for Medicinal Plant Research; September 2-6, 2001; Erlangen, Germany.
34. Markowitz JS, McRae AL, Sonne SC. Oral nutritional supplementation for the alcoholic patient: a brief overview. Ann Clin Psychiatry. 2000;12:153-158.
35. European Scientific Cooperative on Phytotherapy. Valerianae radix [fascicule 4]. Monographs on the Medicinal Uses of Plant Drugs. Exeter, UK: ESCOP;1996-1997:2.
36. Chan TY, Tang CH, Critchley JA. Poisoning due to an over-the-counter hypnotic, Sleep-Qik (hyosine, cyproheptadine, valerian). Postgrad Med J. 1995;71:227-228.
37. Chan TY. An assessment of the delayed effects associated with valerian overdose [letter]. Int J Clin Pharmacol Ther. 1998;36:569.
38. Wiese J, McPherson S, Odden MC, Shlipak MG. Effect of Opuntia ficus indica on symptoms of the alcohol hangover. Arch Intern Med. 2004;164:1334-1340.
39. Pittler MH, White AR, Stevinson C, et al. Effectiveness of artichoke extract in preventing alcohol-induced hangovers: a randomized controlled trial. CMAJ. 2003;169:1269-1273.
40. Trumpler F, Oez S, Stahli P, et al. Acupuncture for alcohol withdrawal: a randomized controlled trial. Alcohol Alcohol. 2003;38:369-375.
41. Lukas SE, Penetar D, Berko J et al. An extract of the Chinese herbal root kudzu reduces alcohol drinking by heavy drinkers in a naturalistic setting. Alcohol Clin Exp Res. 2005;29:756-762.
42. Onyesom I. Honey-induced stimulation of blood ethanol elimination and its influence on serum triacylglycerol and blood pressure in man. Ann Nutr Metab. 2005;49:319-24.
43. Kunz S, Schulz M, Lewitzky M, et al. Ear acupuncture for alcohol withdrawal in comparison with aromatherapy: a randomized-controlled trial. Alcohol Clin Exp Res. 2007;31:436-442.
44. O'Keefe JH, Bybee KA, Lavie CJ. Alcohol and cardiovascular health: the razor-sharp double-edged sword. J Am Coll Cardiol. 2007;50:1009-1014.
45. Rambaldi A, Jacobs B, Gluud C. Milk thistle for alcoholic and/or hepatitis B or C virus liver diseases. Cochrane Database Syst Rev. 2007;CD003620.
46. Saller R, Brignoli R, Melzer J, et al. An updated systematic review with meta-analysis for the clinical evidence of silymarin. Forsch Komplement Med. 2008;15:9-20.
Last reviewed December 2015 by EBSCO CAM Review Board
Last Updated: 12/15/2015
EBSCO Information Services is fully accredited by URAC. URAC is an independent, nonprofit health care accrediting organization dedicated to promoting health care quality through accreditation, certification and commendation.
This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.
To send comments or feedback to our Editorial Team regarding the content please email us at firstname.lastname@example.org. Our Health Library Support team will respond to your email request within 2 business days.