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.

Milk Thistle

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 A 2007 review of published and unpublished studies on milk thistle as a treatment for liver disease concluded that benefits were seen only in low-quality trials, and, even in those, milk thistle did not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.

SAMe

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

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

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

The herb passionflower has been proposed as an aid to alcohol withdrawal, primarily on the basis of the study of people addicted to opiates. 30

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

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 B 3 , 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

Herbs and supplements with the potential to irritate the stomach, such as white willow and arginine , should be used only with caution by people who consume excessive alcohol.