Alternative therapies are popular among individuals with liver failure. The safety and efficacy of some of these products are just now being evaluated. Probiotics are being investigated as potential therapy for hepatic encephalopathy. They may improve encephalopathy via several mechanisms including reduction of ammonia in portal blood, inflammation and oxidative stress in the hepatocyte, and uptake of other toxins .
Many herbal products are promoted to people with liver dysfunction, but there is a lack of safety and efficacy data. Some products that have been identified as being hepatotoxic include borage, chaparral, coltsfoot, comfrey, DHEA, germander, jin bu huan, kava kava, liferoot, pennyroyal, periwinkle, poke root, American skullcap and shark cartilage. Other herbal or alternative medicine supplements may have adverse interactions with medications prescribed to those with liver failure, so caution must be taken in recommending any product.
The two most popular herbal supplements for liver disease are milk thistle and S-adenosyl-methionine (SAMe). Milk thistle contains silymarin, which supposedly reduces free radical production and lipid peroxidation associated with hepatotoxicity; it is also promoted to be an antifibrotic agent . SAMe is a methyl donor for methy-lation reactions and a participant in glutathione (an anti-oxidant) synthesis . Meta-analysis  and Cochrane reviews [49, 50] did not show any beneficial effects of either of these products for patients with liver disease. Until more is known about alternative medicine products, most patients should be cautioned about using any of these products.
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