A nagging question I have about all these liver supports is just how useful they are. There are multiple metabolic pathways through the liver, each with separate damage (from OD) mechanisms and separate repair possibilities that may not apply to other toxic substances. For instance, we know that NAC will stop the toxic shock of a tylenol overdose and this is used in emergency rooms for just this purpose, but does it help at all for the damage caused by e.g. oral dbol? Or in fact is it useless? Or more to the point, which of the liver supps specifically helps with the toxic byproducts of C-17-alpha alkylated steroids? Knowing the answer to that might save folks a lot of money wasted on the non-effective supps.
If any docs (or otherwise medically educated folks) have some input here that would be stupendous!
I wish I knew where to find the research on UDCA and TUDCA that I have read, but it is my understanding that these are the most effective at combating the mechanism of damage by oral steroids. Cholestasis is usually the cause of the liver issues from orals, and this is where TUDCA is effective
edit: since I cannot find the study, here is a sales pitch for Anteus Labs "Aegis" from NutraPlanet: (yes it is a sales pitch but it sums up what several of the studies I remember had said)
Antaeus Labs' Aegis: "The Shield of The Gods", Ultimate Liver Protection!
There are many types of liver injury, but only one is normally associated with the use of oral androgens -- cholestasis. This condition is defined as a failure of normal bile to reach the duodenum, which may be due to a number of different pathological states between the hepatocyte and the ampulla of Vater. When one takes oral androgens (typically methylated at C17a) the physical structure of the hepatocyte is altered -- microfilaments and canaliculi become less contractile. Disruptions in the canalicular bile salt export pump may also occur. This leads to impaired bile flow and the retention of highly cytotoxic hydrophobic bile salts. At low concentrations, these retained bile salts cause apoptosis; at higher concentrations, necrosis and severe liver damage.
This is where Aegis comes into the picture....It was designed with users of oral androgens in mind, and brings together the best anti-cholestatic ingredients available.
Tauroursodeoxycholic Acid:
Can prevent apoptosis during cholestasis. Toxic bile acids produce apoptosis Via fas- and TRAIL- death receptor mediated pathways. Both are, to some degree, dependent on the translocation of the 'bax' pro-apoptoic molecule from the cytosol of hepatocytes to the cell mitochondria. TUDCA prevents bax translocation, strongly stabilizes mitochondrial membranes, and activates the MAPK pro-survival pathway in hepatocytes. (1) These effects protect hepatocytes from bax-related apoptosis.
Is a hydrophilic bile acid, and its presence markedly shifts the bile pool towards hydrophilicity, which, to some extent, detoxifies it. When used consistently, especially at pharmacological doses, TUDCA (along with UDCA) eventually becomes the predominant bile acid in the liver and in general circulation. (2)
Directly stimulates bile secretion via modulating cellular signalling pathways in hepatocytes, such as ERK, src, PKC and others. These signalling pathways generally phosphorylate, or activate, the bile salt export pump (BSEP) and other processes involved in bile export/secretion. (For example, PKC-alpha-mediated secretion of HCO3-.) (3, 4, 5)
Polyenylphosphatidylcholine:
Stabilizes cellular membranes and dilates bile canaliculi. This former effect has been shown to protect human cells from hydrophobic bile salt induced apoptosis (6), and the latter may serve to counteract the reduction in contractility seen in androgen-induced cholestasis. (7)
Oral androgen administration may decrease hepatic Na+, K+-ATPase, Ca2+, Mg2+-ATPase and F-actin levels --- all of which may be restored, and even raised, by polyenylphosphatidylcholine administration. (8)
Is secreted into bile by hepatocytes, where it serves as a major component of the micelles in which bile acids are emulsified. Increased levels of biliary phosphatidylcholine reduces the cytotoxicity of bile acids, whereas phosphatidylcholine-secretion impairment (as is often seen in ABCB4 disease) is characterized by extremely severe cholestatic liver disease. (9)
To summarize:
Aegis is highly-potent, highly-specific liver protection for people taking hepatotoxic oral androgens. Superior protection cannot be bought, nor should it be needed.