The Encyclopedia of Natural Medicine, 3rd Ed.

Hepatitis

images

• Prodrome of loss of appetite, nausea, vomiting, fatigue, and flu-like symptoms that can occur two weeks to one month before liver involvement, depending upon the incubation period of the virus

• Symptoms may occur abruptly or rather insidiously

• Fever; enlarged, tender liver; jaundice (yellow appearance of the skin and whites of the eye)

• Dark urine

• Normal to low white blood cell count; markedly elevated liver enzymes (aminotransaminases) in the blood; elevated bilirubin levels

Hepatitis (inflammation of the liver) can be caused by many drugs and toxic chemicals, but in most instances it is caused by a virus. Viral types A, B, and C are the most common. Hepatitis A occurs sporadically or in epidemics, and is transmitted primarily through fecal contamination. Hepatitis B is transmitted through infected blood or blood products as well as through sexual contact (the virus is shed in saliva, semen, and vaginal secretions). Hepatitis C (formerly known as non-A, non-B hepatitis) can be transmitted through blood transfusions or intravenous drug use, but in some cases the source of infection is unclear; the mortality rate (1% to 12%) is much higher than that for the other forms. Other viral causes of hepatitis include hepatitis viruses D, E, and G, as well as herpes simplex, cytomegalovirus, and Epstein-Barr virus.

Acute viral hepatitis can be an extremely debilitating disease requiring bed rest. Recovery can take anywhere from 2 to 16 weeks. Most patients recover completely (usually by 9 weeks in type A and 16 weeks in B, C, D, and G). However, about 1 out of 100 people infected with hepatitis dies, and 10% of hepatitis B cases and 10 to 40% of hepatitis C cases develop into chronic viral hepatitis forms (hepatitis C contracted from a transfusion is associated with a 70 to 80% rate of development of chronic hepatitis). The symptoms of chronic hepatitis vary: they can be virtually nonexistent or they can lead to chronic fatigue, serious liver damage, and even death due to cirrhosis of the liver or liver cancer.

Diagnostic Considerations

Diagnosis is based on the appearance of the typical signs and symptoms (listed in the table opposite) along with blood tests showing elevation in liver enzymes (such as SGPT, GGPT, SGOT, and alkaline phosphatase, which leak out into the blood when liver cells are damaged) and the presence of viral antigens (compounds recognized as being foreign to the body and resulting in the formation of antibodies against them) or the antibodies that bind antigens. The type of virus involved is determined by identifying viral antigens or specific antibodies in the blood.

Incidence of Symptoms in Viral Hepatitis1

SYMPTOM

% OF PATIENTS SUFFERING FROM IT

Dark urine

94

Fatigue

91

Loss of appetite

90

Nausea

87

Fever

76

Vomiting

71

Headache

70

Abdominal discomfort

65

Light stools

52

Muscle pain

52

Drowsiness

49

Irritability

43

Itching

42

Diarrhea

25

Joint pain

21

In cases of chronic hepatitis B or C it is necessary to perform continued blood evaluation to monitor progression or clearance of the infection. In addition to liver enzymes, hepatitis C is monitored by the presence of hepatitis C viral RNA by polymerase chain reaction (HCV-RNA[PCR]). The higher the level of HCV-RNA, the more aggressive the chronic infection.

Prevention Strategies

Hepatitis A

For primary prevention of hepatitis A, the Centers for Disease Control (CDC) recommends vaccination for three categories of people: (1) children living in areas with high rates of hepatitis A; (2) people at increased risk, such as travelers to endemic regions, men having sex with men, illegal drug users, employees in research laboratories who work with hepatitis A, and individuals with clotting factor disorders needing blood components; (3) people with chronic liver disease, especially chronic hepatitis B or C. Vaccination is also advised during outbreaks in communities with higher rates of hepatitis A.2,3Postexposure prevention consists of injections of specific hepatitis A immune globulins (antibodies) during the first two weeks after an individual has been exposed.4

Hepatitis B

Vaccination is prudent for those in high-risk occupations, such as members of the medical and dental fields who regularly encounter blood and other body fluids. In the case of exposure to the hepatitis B virus (HBV), hyperimmune globulin is administered in a series of two injections within two weeks of exposure. It is said to confer adequate protective immunity to 75% of exposed individuals, though the protection lasts for only three months.

Newborns whose mothers are positive for hepatitis B surface antigen (HBsAg) should also receive the vaccine shortly after birth and again at ages three and six months.

Hepatitis C

As there is currently no vaccine for hepatitis C, prevention entails minimizing routes of infection. Because 50 to 80% of IV drug abusers get infected during the first year,4 cessation of IV drug use or using only previously unused, clean, sterile needles is recommended. Similarly, modifying or ceasing intranasal cocaine use decreases risk. Accepting blood transfusions only from blood sources known to be uncontaminated also curtails a major risk factor.

Health care workers should practice strict occupational safety and health standards, especially when dealing with blood products, and should never recap used needles, to avoid needle stick transmission.

Although sexual transmission is an inefficient method of transfer, the risk is higher in male homosexuals, patients with multiple sexual partners, and those with sexually transmitted diseases.4 Someone in a monogamous heterosexual relationship with a hepatitis C patient has a low risk of infection unless the patient is coinfected with hepatitis C and human immunodeficiency virus (HIV).

Therapeutic Considerations

Natural therapies can be of great benefit in hepatitis, but the disease requires proper medical care and supervision. Several nutrients and herbs have been shown to inhibit viral reproduction, improve immune system function, and greatly stimulate regeneration of damaged liver cells. General therapies to protect and support the liver are discussed in more detail in the chapter “Detoxification and Internal Cleansing.” Those recommendations can be used in conjunction with the more specific recommendations given in this chapter.

It is absolutely essential to be aggressive in the treatment of chronic hepatitis due to the increased risk for liver cancer and cirrhosis. If cirrhosis is present in chronic hepatitis B, for example, the five-year survival rate is just 50 to 60%.

The best available conventional drug treatment for chronic hepatitis is the combination of pegylated interferon and ribavirin. Unfortunately, this regimen is costly, is fraught with side effects, and eradicates hepatitis C in only 50% to 70% of patients at best.1 However, patients with hepatitis can greatly benefit from natural therapies.

Diet

During the acute hepatitis phase, the focus should be on replacing fluids through consumption of vegetable broths, vegetable juices diluted with an equal amount of water, and herbal teas. Solid foods should be restricted to brown rice, steamed vegetables, and moderate intake of lean protein sources.

In chronic cases, follow the dietary recommendations in the chapter “A Health-Promoting Diet.” The diet should definitely be low in saturated fats, simple carbohydrates (e.g., sugar, white flour, fruit juice, honey), oxidized fatty acids (oils used for frying), and animal products. A diet that focuses on plant foods (i.e., a high-fiber diet) has been shown to increase the elimination of bile acids, drugs, and toxic bile substances from the system. Alcohol should be completely avoided.

Nutritional Supplements

Vitamin C

According to nutritional medicine pioneer Robert Cathcart, M.D., acute hepatitis is one of the easiest diseases for vitamin C to cure.5,6 Cathcart demonstrated that high dosages of vitamin C (40 to 100 g orally or intravenously per day) were able to greatly improve acute viral hepatitis in two to four days and to clear jaundice within six days.6 Other studies demonstrated similar benefits.79 A controlled study found that 2 g per day or more of vitamin C was able to dramatically prevent hepatitis B in hospitalized patients. Although 7% of the control patients (receiving less than 1.5 g per day of vitamin C) developed hepatitis, none of the treated patients did.10

Selenium

Selenium is a trace element required for the activity of the antioxidant enzyme glutathione peroxidase. Selenium deficiency is associated with immune system dysfunction, cancer, and liver damage. Whole blood and plasma selenium levels in 59 patients with chronic liver disease including alcoholic and viral liver cirrhosis were found to be significantly lower when compared with those in healthy controls.11Another study revealed that liver cancer cells are able to acquire a selective survival advantage that is prominent under conditions of selenium deficiency and oxidative stress.12 Oxidative stress is a well-known feature in late-stage cirrhotic liver disease, but subsequent study has found that this type of oxidant stress actually occurs much earlier than previously believed.13 Given this information and the safety of selenium when used in doses under 400 mcg, it is reasonable to employ selenium for treatment of hepatitis.

Alpha-Lipoic Acid

Alpha-lipoic acid is a sulfur-containing compound produced by the cells of the body. It has a role in energy metabolism and is also a valuable antioxidant. Alpha-lipoic acid has been successfully used to treat a number of conditions relating to liver disease, including alcohol-induced damage, metal intoxication, carbon tetrachloride poisoning, and amanita mushroom poisoning, as well as hepatitis C.1416

Vitamin D

New research is showing that vitamin D not only is directly antiviral—specifically against hepatitis C—but also promotes immune function that is critical to helping the body eliminate the virus.17 Several studies have now used vitamin D in conjunction with conventional antiviral drugs, resulting in improved outcomes.18 People with low blood vitamin D levels are much more likely to have more serious cases of hepatitis that progress to chronic hepatitis, as well as to develop cirrhosis.19 One study found that more than 90% of patients with chronic hepatitis C had low levels of vitamin D.20

Botanical Medicines

Although long-term clinical trials have yet to confirm the efficacy of plant medicines, several have been investigated for their effects in viral hepatitis. The two with the greatest amount of positive documentation are licorice (Glycyrrhiza glabra) and silymarin (the flavonoid complex from milk thistle, Silybum marianum). A third, Phyllanthus amarus, sparked considerable excitement on the basis of preliminary results, but detailed follow-up studies showed it to provide no benefit.21

Licorice Root

Licorice (Glycyrrhiza glabra) exerts many actions beneficial in the treatment of acute and chronic hepatitis, including protecting the liver, enhancing the immune system, potentiating interferon (the body’s own antiviral and immune-enhancing agent), and promoting the flow of bile and fat to and from the liver. In addition, licorice root is directly antiviral. Clinical studies with a product in Japan containing glycyrrhizin—the key component of licorice—have shown excellent results in the treatment of acute and chronic hepatitis. The product, Stronger Neominophagen C (SNMC), consists of 200 mg glycyrrhizin, 100 mg cysteine, and 2,000 mg glycine in 100 ml physiological saline solution. It is administered intravenously, though oral administration may be just as effective, as discussed below.2226

SNMC has demonstrated impressive results in treating chronic hepatitis B or C. Approximately 40% of patients will have complete resolution—a proportion that compares quite favorably with alpha-interferon’s 40 to 50% clearance rate. Like SNMC, alpha-interferon administration has been shown to lead to dramatic reductions in the risk for liver cancer. However, it is expensive and causes side effects (primarily fever, joint pain, nausea, and flu-like symptoms) in all patients.

In a recent study of 453 patients diagnosed with chronic hepatitis C at a hospital in Japan between 1979 and 1984, 84 patients were treated with SNMC at a dosage of 100 ml per day for eight weeks followed by treatments two to seven times weekly for periods up to 16 years.26 The 15th-year cumulative rates of liver cancer and cirrhosis were 7% and 12%, respectively. The numbers are consistent with alpha-interferon’s success rates in both patients at early stages of the disease (0.6% per year progression to liver cancer with alpha-interferon and 0.7% for SNMC) and those at advanced stages (1.5% per year progression to liver cancer in alpha-interferon-treated patients compared with 1.3% for those treated with SNMC).

Although the studies with SNMC utilized injectable glycyrrhizin, injection may not be necessary, as glycyrrhizin is readily absorbed from licorice. The goal is to achieve a high level of glycyrrhizin in the blood without producing side effects. The dosages given in the “Treatment Summary” section below provide roughly half the dosage of glycyrrhizin used in the studies with SNMC. Over longer periods, licorice root (more than 3 g per day for more than six weeks) or glycyrrhizin (more than 100 mg per day) may cause sodium and water retention, leading to high blood pressure. Monitoring blood pressure, increasing dietary potassium intake, and following a low-sodium diet are suggested.27 There is great individual variation in susceptibility to the blood-pressure-elevating effects of licorice. While adverse effects are quite common at levels above 400 mg per day, they are rarely observed at levels below 100 mg per day.27 Nonetheless, licorice should probably not be used by patients with a history of hypertension or renal failure, or by patients currently using digitalis preparations.

Milk Thistle

Milk thistle (Silybum marianum) contains silymarin, a mixture of flavonolignans consisting chiefly of silybin, silidianin, and silichristine. Silymarin is one of the most potent liver-protecting substances known. Silymarin inhibits hepatic damage by doing the following:

• Acting as a direct antioxidant and free radical scavenger

• Increasing the content of the protective compounds glutathione and superoxide dismutase within the liver cells

• Inhibiting the formation of inflammatory compounds that can damage liver cells

• Stimulating liver cell regeneration

Silymarin is effective in both acute and chronic viral hepatitis. In one study of acute viral hepatitis, 29 patients treated with silymarin showed a reduction in serum levels of bilirubin and liver enzymes after five days compared with a placebo group.28 The number of patients attaining normal liver values after three weeks of treatment was significantly higher in the silymarin group than in the placebo group.

In a study of chronic viral hepatitis, silymarin was shown to result in dramatic improvement. High doses (420 mg per day) of silymarin for periods of 3 to 12 months resulted in a reversal of liver cell damage (as noted by biopsy), an increase in protein level in the blood, and a lowering of liver enzymes. Common symptoms of hepatitis (e.g., abdominal discomfort, decreased appetite, fatigue) all improved.29

Silymarin phytosome is a newer form of silymarin, bound to phosphatidylcholine, that may provide even greater benefit. A growing body of scientific research indicates that phosphatidylcholine-bound silymarin is better absorbed and produces better clinical results than unbound silymarin.3035 These benefits were demonstrated in one study involving 232 patients with chronic hepatitis (viral, alcohol-related, or chemically induced) treated with silymarin phytosome at a dose of either 120 mg twice per day or 120 mg three times per day for up to 120 days.35 An additional 49 patients were treated with a commercially available unbound silymarin, while 117 were untreated or given a placebo. Liver function returned to normal faster in all patients given silymarin phytosome, compared with those given the commercially available silymarin and those who received the placebo.

Silymarin has low toxicity and is well tolerated. However, because it stimulates bile flow, it may produce a looser stool. If higher doses are used, it may be appropriate to use bile-sequestering fiber compounds (e.g., guar gum, pectin, psyllium, oat bran) to prevent mucosal irritation and loose stools. Because of silymarin’s lack of toxicity, long-term use is appropriate.

image

QUICK REVIEW

• Hepatitis is a serious disease requiring the care of a physician.

• Several nutrients and herbs have been shown to inhibit viral reproduction, improve immune system function, and greatly stimulate regeneration of damaged liver cells.

• In the case of acute exposure to the hepatitis B virus, hyperimmune globulin is administered by injection.

• During the acute phase, the focus should be on replacing fluids through consumption of vegetable broths, diluted vegetable juices, and herbal teas.

• In chronic cases, the diet should be low in saturated fats, simple carbohydrates, oxidized fatty acids, and animal products.

• High dosages of vitamin C (40 to 100 g orally or intravenously) are able to greatly improve acute viral hepatitis in two to four days.

• Licorice exerts many actions beneficial in the treatment of acute and chronic hepatitis, including protecting the liver, enhancing the immune system, and potentiating interferon.

• Silymarin, the flavonoid complex from milk thistle, is effective in both acute and chronic viral hepatitis.

• A growing body of scientific research indicates that silymarin phytosome is better absorbed and produces better clinical results than unbound silymarin.

image

TREATMENT SUMMARY

In cases of hepatitis, natural medicine’s therapeutic goals are to prevent further damage to the liver by supporting the immune system, decrease viral load, and protect the liver. Bed rest is important during the acute phase of viral hepatitis, with slow resumption of activities as health improves. Strenuous exertion, alcohol, and other liver-toxic drugs and chemicals should be avoided. During the contagious phase (two to three weeks before symptoms appear to three weeks after), there is not much that can be done unless there is prior knowledge of infection, in which case careful hygiene and avoiding close contact with others is important. Once diagnosis is made at any point, work that involves public contact, such as work in day care centers, restaurants, and similar places, is not recommended.

Diet

During the acute phase, the focus should be on replacing fluids through consumption of vegetable broths, vegetable juices diluted with an equal amount of water, and herbal teas.

In the chronic phase, follow the guidelines in the chapter “A Health-Promoting Diet.” Certain foods are particularly helpful because they contain the nutrients your body needs in order to produce and activate the dozens of enzymes involved in the various phases of detoxification. These foods include:

• Garlic, legumes, onions, eggs, and other foods with a high sulfur content

• Good sources of water-soluble fiber, such as pears, oat bran, apples, and legumes

• Vegetables in the brassica family, especially broccoli, brussels sprouts, and cabbage

• Artichokes, beets, carrots, dandelion greens, and many herbs and spices such as turmeric, cinnamon, and licorice

• Green foods such as wheatgrass juice, dehydrated barley grass juice, chlorella, and spirulina

Nutritional Supplements

• A high-potency multiple vitamin and mineral formula as described in the chapter “Supplementary Measures”

• Fish oils: 1,000 mg EPA + DHA

• Vitamin C: 500 to 1,000 mg three times per day

• Vitamin D: 2,000 to 4,000 IU per day (ideally, measure blood levels and adjust dosage accordingly)

• One of the following:

  images Grape seed extract (>95% procyanidolic oligomers): 150 to 300 mg per day

  images Pine bark extract (>95% procyanidolic oligomers): 150 to 300 mg per day

Botanical Medicines

• Licorice (Glycyrrhiza glabra):

  images Powdered root: 1 to 2 g three times a day

  images Fluid extract (1:1): 2 to 4 ml three times a day

  images Solid (dry powdered) extract (5% glycyrrhetinic acid content): 250 to 500 mg three times a day

Note: If licorice is to be used over a long period of time, it is necessary to increase the intake of potassium-rich foods.

• Milk thistle (Silybum marianum): Dosage is based on silymarin content (standardized extracts are preferred), and the best results are achieved at higher dosages, i.e., 140 mg to 210 mg silymarin three times per day; dosage for silymarin phytosome is 120 mg two to three times per day between meals.