Monday, August 19, 2013

Coffee May Offer Real Benefits to the Liver

Source: Clinical Care Options - ClinicalThought
Coffee May Offer Real Benefits to the Liver
8/13/2013  More from this author

Mixed Realities of Alternative Therapies for Hepatitis
Approximately 50% of patients who have failed initial therapy for hepatitis C take some form of alternative or complementary therapy. In my practice, I’m frequently asked by these and other patients: “What can I do to help my liver?” Most have heard of, have taken, or are taking milk thistle, licorice root, ginseng, schisandra, and/or thymus extract—with milk thistle being the most common. Not all alternative therapies are created equal and there are few randomized controlled trials to guide clinicians seeking answers. For instance, the active ingredient in milk thistle, silymarin, has been evaluated and generally found to provide little or no clinical benefit to the liver. In fact, a recent study found that even at higher-than-usual doses, silymarin failed to reduce HCV RNA or ALT levels more than placebo.

There is, however, a growing body of research supporting a beverage I’d wager a majority of you have enjoyed today: coffee.

The Coffee Alternative
Curiously, patients who will spend up to $30 a day or more for milk thistle and its extracts or ingest unproven therapies of varying quality are skeptical about the idea that drinking coffee can actually be good for you. Real and perceived cardiovascular and other effects of coffee have led many patients to view coffee as “unhealthy.” But the reality is that coffee consumption has been linked to a number of potential benefits – lower risk of diabetes, dementia and, yes, liver disease. Coffee contains more than 1000 compounds; one or more of which is responsible for the benefit that has been linked to coffee intake on liver disease in patients with alcoholic and viral hepatitis. Benefits include decreases in markers of liver disease progression and reductions in the risk for fibrosis and hepatocellular carcinoma.

Epidemiologic studies have suggested that there is a cause and effect associated with coffee intake and its benefits on the liver. These findings are supported by the few randomized controlled trials available. In one study comparing patients infected with hepatitis C, those who drank 3 cups of coffee per day or more received the greatest benefit. In order to maximize the effects of the coffee some (but not all) studies suggest that caffeinated coffee may be better for the liver than decaffeinated coffee. However, it seems that caffeine itself does not appear to have a beneficial effect.

There is also an interesting conundrum. Not just any caffeinated beverage will do. For instance, studies evaluating the effect of green tea – popularly considered a “healthier” source of caffeine – have not shown the benefits associated with filtered, caffeinated coffee. This lack of benefit appears to be true for sources of caffeine other than green tea as well.

Lastly, coffee should ideally be prepared by filtration because filtering removes cafestol and kahweol, two substances found in coffee that may increase serum cholesterol.

So, What Do We Tell Our Patients?
Simply put: moderation and common sense are my watchwords. Investigate what you are taking. What’s in it, by whom and how is it manufactured? Is there any literature supporting its use, or recommending against it? Natural, alternative, and complementary substances may provide benefits, but there are far too many tragic stories in the scientific popular press to proceed without caution. For example, in the late 1990s, several cases were reported of previously healthy patients who presented with a toxic serum digoxin level after the ingestion of botanical dietary supplements due to contamination of the natural product.

I support my hepatitis patients’ interests in adding natural products to a “liver healthy” lifestyle which include no alcohol, daily exercise and maintaining a normal body mass index. So, I discuss the data supporting moderate coffee intake of 2-3 cups per day in addition to abstaining from alcohol use, achieving or maintaining a normal BMI by eating a low fat, low cholesterol diet, and taking a curative hepatitis therapy. Of course, when patients are taking antiviral therapy, I recommend that patients limit their intake of all complementary and alternative therapies to avoid the potential for drug-drug interaction that can undermine the efficacy of treatment or increase the risk of toxicity. Despite this pragmatism, many of my patients are surprised by my willingness to accept a nontraditional adjunct to care, but my acceptance is based on data from respected sources. What could be more traditional than that?

Your Thoughts?
I am interested to hear your own experiences with patients’ use of alternative or complementary therapies for hepatitis. How do you approach their use by patients and how many of your patients use them? Do you recommend any in particular or, conversely, do you recommend against them altogether?

Topics: HBV - Treatment, HCV - Treatment
Related: Impact of Coffee on Liver Diseases: A Systematic Review
In this August 2013 systematic review offered online at Liver International, researchers investigated several studies assessing the effect of coffee on liver disease.
The abstract, introduction and discussion "only" are provided on the blog, here,  The complete review article is available in a PDF format published in Liver International found in Accepted Articles. In addition, posted over at Healio is an easy to read summary of the article:Studies indicate protective effects of coffee for liver disease  
Coffee and Tea May Contribute to a Healthy Liver 
Surprise! Your morning cup of tea or coffee may be doing more than just perking you up before work.

Behind the Headlines - Can excess coffee intake lead to an 'early grave'?
“More than four cups of coffee a day increases the risk of an early death,” The Daily Telegraph warns, on the basis of a large, long-term – but rather flawed – study.

Caffeinated drinks may be good for the liver
The study's researchers show that caffeine reduces fat content within the liver and "stimulates β-oxidation in hepatic cells and liver via an autophagy-lysosomal pathway."
Paul Yen, associate professor at Duke NUS, says: This is the first detailed study of the mechanism for caffeine action on lipids in liver and the results are very interesting. Coffee and tea are so commonly consumed and the notion that they may be therapeutic, especially since they have a reputation for being 'bad' for health, is especially enlightening."


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