Hepatitis

Also indexed as: Inflammation (Liver)

Hepatitis is a liver disease that can result from long-term alcohol abuse, infection, or exposure to various chemicals and drugs. Because hepatitis is potentially very dangerous, a healthcare professional should be involved in its treatment.

Checklist for Hepatitis

Rating Nutritional Supplements Herbs
3Stars Flavonoids (catechin)  
2Stars Betaine (for nonalcoholic steatohepatitis)
S-adenosylmethionine (SAMe) (for liver cholestasis)
Thiamine
Thymus extracts
Zinc (as zinc-L-carnosine, in combination with interferon, for hepatitis C)		 Bupleurum
Licorice (intravenous glycyrrhizin)
Milk thistle
Peony
Phyllanthus
1Star Alpha lipoic acid
Phosphatidylcholine
Selenium
Vitamin B12
Vitamin C
Vitamin E		 Andrographis
Astragalus
Chinese scullcap
Licorice (oral glycyrrhizin)
Picrorhiza
Reishi
Schisandra
Shiitake
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

What are the symptoms of hepatitis? Acute viral hepatitis varies from a minor flu-like illness to an overwhelming infection resulting in liver failure and death. The early phase is characterized by loss of appetite, malaise, nausea and vomiting, and fever. Signs include a darkening of the urine and jaundice (yellowing of the skin and whites of the eyes). Chronic hepatitis may be asymptomatic, or may manifest as malaise, fatigue, loss of appetite and a low-grade fever.

How is it treated? Acute hepatitis generally resolves without treatment. Treatment of chronic hepatitis includes cessation of causative drugs (e.g., alcohol). Autoimmune hepatitis is usually treated with corticosteroids. Therapy for chronic hepatitis B and C is evolving and may include interferon, and antiviral and immune-modulating drugs. In the late stages of certain types of hepatitis (not hepatitis B, generally), liver transplantation may be required to preserve life.

Lifestyle changes that may be helpful: Avoiding alcohol is the most obvious way to avoid the liver damage it causes.

A variety of prescription drugs can, on rare occasions, cause hepatitis, as can large amounts of niacin or niacinamide (forms of vitamin B3). Excessive intake of acetaminophen or other painkillers can damage the liver, so excessive intake of these drugs should be avoided. People with hepatitis C who failed to respond to interferon therapy have been found to have a higher amount of iron within the liver.1 People with hepatitis C should, therefore, avoid iron supplements. People with any type of hepatitis should ask their physician whether any medication they are taking poses a risk to the liver.

For infectious (viral) hepatitis, good hygiene is necessary to avoid spreading the infection. The hepatitis A virus can be spread very easily through food that is handled by infected individuals; therefore, people with hepatitis A should wash their hands very carefully after using the restroom and should not handle food at work. The hepatitis viruses B and C are both transmitted by blood and sexual contact.

Nutritional supplements that may be helpful: Catechin, a flavonoid, has helped people with acute viral hepatitis,2 as well as individuals with chronic hepatitis,3 though not all trials have found a benefit.4 A typical amount used in successful trials is 500–750 mg three times per day. Although catechin is found in several plants, none contain sufficient amounts to reach the level used in the trials; thus, catechin supplements are needed. However, because of its potential to cause side effects on rare occasions,5 catechin should be used only under medical supervision.

Proteins from the thymus gland, an important part of the immune system, may have a beneficial effect in people with chronic hepatitis B. Initial trials done in Poland used injected thymus proteins with good results.6 Further trials using a variety of thymus extracts by mouth have found that they can improve blood tests that measure liver damage as well as improve immune cell numbers.7 8 Preliminary evidence also suggests these extracts may help patients with hepatitis C.9 The standard recommendation for supplementation is 200 mg three times per day of crude extracts or 40 mg three times per day of purified proteins.

S-adenosylmethionine (SAMe) (1,600 mg/day orally or 800 mg/day intravenously) has been shown to aid in the resolution of blocked bile flow (cholestasis), a common complication of chronic hepatitis.10 11

Taking 3 grams per day of phosphatidylcholine (found in lecithin) was found to be beneficial in one investigation of people with chronic hepatitis B.12 Signs of liver damage on biopsy were significantly reduced in this trial.

Vitamin E levels have been shown to be low in people with hepatitis,13 as well as in those who later develop liver cancer from long-standing hepatitis.14 Vitamin E levels in the liver may also be decreased in some people with hepatitis.15 In a controlled trial of individuals with hepatitis B, 600 IU of vitamin E per day for nine months resulted in all signs of hepatitis disappearing in five of twelve people.16 In a preliminary trial of adults with hepatitis C, administering 1,200 IU per day of vitamin E for eight weeks appeared to reduce liver damage to some extent.17 In a preliminary trial of people with hepatitis C, 544 IU of vitamin E per day for 24 weeks improved the response to interferon/antioxidant therapy, although the results did not reach statistical significance.18 However, in children with viral hepatitis, daily injections of vitamin E (300 IU) for seven days did not produce any benefit.19

Vitamin C in the amount of 2 grams per day was reported in a preliminary trial to prevent hepatitis infection in individuals receiving blood transfusions.20 This report was followed up by a double-blind trial, in which 3.2 grams per day of vitamin C was reported to have no protective effect against post-transfusion hepatitis.21 (However, in the latter trial, vitamin C actually reduced the incidence of hepatitis by 29%, although this reduction was not statistically significant.) An older trial suggested that injections of vitamin C may be helpful in treating viral hepatitis.22

A potent antioxidant combination may protect the liver from damage in people with hepatitis C, possibly decreasing the necessity for a liver transplant. In a preliminary trial,23 three people with liver cirrhosis and esophageal varices (dilated veins in the esophagus that can rupture and cause fatal bleeding) caused by hepatitis C received a combination of Alpha lipoic acid (300 mg twice daily), silymarin (from milk thistle; 300 mg three times daily), and selenium (selenomethionine; 200 mcg twice daily). After five to eight months of therapy that included other “supportive supplements,” such as vitamin C and B vitamins, all three people had significant improvements in their liver function and overall health. Larger clinical trials are needed to confirm these promising preliminary results.

Vitamin B12 (with or without folic acid) has been reported in trials from the 1950s to help some people with hepatitis.24 25 Vitamin B12 injections are likely to be more beneficial than oral administration, though 1,000 mcg (taken orally) each day can also be supplemented.

In a preliminary report, three patients with chronic hepatitis B had an improvement in the severity of their hepatitis after taking 100 mg of thiamine (vitamin B1) per day.26

In a preliminary trial, supplementation with betaine (20 grams per day) for 12 months improved signs of liver inflammation in seven patients with nonalcoholic steatohepatitis, a type of liver inflammation. No significant side effects were seen.27

Supplementation with 17 mg of zinc twice a day (in the form of a zinc complex of L-carnosine) enhanced the response to interferon therapy in patients with chronic hepatitis C, in a preliminary trial.28 It is not known whether this benefit was due primarily to the zinc or the carnosine, or whether other forms of zinc would have the same effect.

Are there any side effects or interactions? Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful: Silymarin, the flavonoid extracted from milk thistle, has been studied for treating all types of liver disease. The standard amount used in most trials has delivered 420 mg of silymarin per day. For acute hepatitis, double-blind trials have shown mixed results.29 30 A preparation of silymarin and phosphatidylcholine was reported to help sufferers of chronic viral hepatitis. One small preliminary trial found that at least 420 mg of silymarin was necessary each day.31 A controlled trial found that silymarin decreased liver damage.32 One trial has suggested that silymarin may be more effective for hepatitis B as opposed to hepatitis C.33

Recent findings have shown that silymarin has the ability to block fibrosis, a process that contributes to the eventual development of cirrhosis in persons with inflammatory liver conditions secondary to alcohol abuse or hepatitis.34 While there are no published clinical trials in people with hepatitis C to date, this action makes milk thistle extract potentially attractive as a supportive treatment for the condition—particularly for those that have not responded to standard drug therapy. The effectiveness of silymarin (particularly its antifibrotic actions) needs to be studied in larger numbers of persons with hepatitis C to determine whether it is an effective treatment for this condition.

Phyllanthus (Phyllanthus amarus), an Ayurvedic herb, has been studied primarily in carriers of the hepatitis B virus, as opposed to those with chronic active hepatitis. In one trial, administering this herb for 30 days appeared to eliminate the hepatitis B virus in 22 of 37 cases (59%).35 However, other trials have failed to confirm a beneficial effect of Phyllanthus amarus against hepatitis B.36 37 A West Indian species, Phyllanthus urinaria (not widely available in the United States or Europe), has achieved much better results than Indian Phyllanthus amarus. 38 Thus, the specific plant species used may have a significant impact on the results. The amount of phyllanthus used in clinical trials has ranged from 900–2,700 mg per day.

A crude extract of red peony root was shown in a small, preliminary trial to reduce cirrhosis in some people with chronic viral hepatitis.39 Other preliminary trials published in Chinese demonstrated that red peony root was helpful (by reducing liver enzyme levels or symptoms or both) for people with viral hepatitis.40

Preliminary trials have shown that the bupleurum-containing formula sho-saiko-to can help reduce symptoms and blood liver enzyme levels in children and adults with chronic active viral hepatitis.41 42 43 44 Most of theses trials were in people with hepatitis B infection, though one preliminary trial has also shown a benefit in people with hepatitis C.45 Sho-saiko-to was also found, in a large preliminary trial to decrease the risk of people with chronic viral hepatitis developing liver cancer. However, people who had a sign of recent hepatitis B infection were not as strongly protected in this trial.46 The usual amount of sho-saiko-to used is 2.5 grams three times daily. Sho-saiko-to should not be used together with interferon drug therapy as it may increase risk of pneumonitis - a potentially dangerous inflammation in the lungs.47

One of the active constituents in licorice, glycyrrhizin, is sometimes used in Japan as an injected therapy for hepatitis B and C.48 49 Glycyrrhizin also blocks hepatitis A virus from replicating in test tubes.50 One preliminary trial found that use of 2.5 grams licorice three times per day providing 750 mg glycyrrhizin was superior to the drug inosine polyIC in helping people with acute and chronic viral hepatitis.51 Because glycyrrhizin can cause high blood pressure and other problems, it should only be taken on the advice of a healthcare practitioner.

A series of cases of acute viral hepatitis were reported by one group in India, showing picrorhiza, combined with a variety of minerals, to be helpful in hastening recovery.52 A variety of similar reports have appeared in the Indian literature over the years, although no double-blind clinical trials have yet been published. Between 400 and 1,500 mg of powdered, encapsulated picrorhiza per day has been used in a variety of trials. Andrographis, another traditional Indian herb, has shown preliminary benefit for people with chronic viral hepatitis.53

Preliminary human research demonstrates some efficacy for the mushroom reishi in treating chronic hepatitis B; however, additional clinical trials are needed.54

An uncontrolled trial found that shiitake formulations containing Lentinus edodes mycelium (LEM— the powdered mycelium of the mushroom before the cap and stem grow) may help decrease blood markers of liver inflammation.55 One marker of hepatitis B infection in the blood (HBeAg) disappeared in 14% of the patients in this trial. Given the preliminary nature of the research, more information is needed to determine if LEM is effective for hepatitis.

Modern Chinese research suggests that compounds called lignans in schisandra promote regeneration of liver tissue that has been damaged by harmful influences, such as hepatitis viruses or alcohol. In a controlled trial, Chinese patients with chronic viral hepatitis were given 500 mg schisandra extract three times daily or liver extract and B vitamins.56 Among those given schisandra, serum glutamic pyruvic transaminase (SGPT) levels declined to normal levels in 68% compared to 44% of the control group. Lower SGPT levels suggest less liver inflammation. There was also a reduction in symptoms such as insomnia, fatigue, loose stools, and abdominal tension in the schisandra group. A preliminary trial in 5,000 people with various types of hepatitis found normalizations in SGPT or related liver enzymes in 75% of cases using an unspecified amount of schisandra.57

Early clinical trials in China suggest astragalus root might benefit people with chronic viral hepatitis, though it may take one to two months to see results.58 Textbooks on Chinese herbs recommend taking 9–15 grams of the crude herb per day in decoction form. A decoction is made by boiling the root in water for a few minutes and then brewing the tea.

Another Chinese herb, Chinese scullcap, might be useful for liver infections. However, the research on this is generally of low quality.59

Are there any side effects or interactions? Refer to the individual herb for information about any side effects or interactions.

References:

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10. Frezza M, Centini G, Cammareri G, et al. S-adenosylmethionine for the treatment of intrahepatic cholestasis of pregnancy. Results of a controlled clinical trial. Hepatogastroenterology 1990;37 Suppl 2:122–5.

11. Frezza M, Surrenti C, Manzillo G, et al. Oral S-adenosylmethionine in the symptomatic treatment of intrahepatic cholestasis. A double-blind, placebo-controlled study. Gastroenterology 1990;99:211–5.

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32. Buzzelli G, Moscarella S, Giusti A, et al. A pilot study on the liver protective effect of silybinphosphatidylcholine complex (IdB 1016) in chronic active hepatitis. Int J Clin Pharmacol Ther Toxicol 1993;31:456–60.

33. Lirussi F, Okolicsanyi L. Cytoprotection in the nineties: experience with ursodeoxycholic acid and silymarin in chronic liver disease. Acta Physiol Hung 1992;80:363–7.

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