Natural Therapies
Conventional hepatitis C therapy focuses on reducing the viral load through the use of pegylated interferon and ribavirin. While this mode of therapy may be effective in reducing the viral count, it does nothing to address the ongoing liver damage caused by the hepatitis C virus. During hepatitis C infection, the liver is besieged with free radicals that consume internal antioxidants and eventually kill liver cells. (These dead cells release liver enzymes into the blood, which explains why monitoring liver enzyme levels is valuable.)
There is some controversy surrounding therapies that are designed to lower liver enzyme levels. Levels of liver enzymes are not necessarily predictive of viral activity or viral load. However, reducing liver enzymes may provide a verifiable way of reducing liver damage.
Ursodeoxycholic acid. Ursodeoxycholic acid is a naturally occurring bile acid found in small quantities in the liver. A synthetic form known as ursodiol helps dissolve gallstones in those who cannot have gallbladder surgery or who do not need surgery. Ursodiol has low liver toxicity. When taken as a medication, it replaces some of the more toxic liver bile salts. In research related to hepatitis C, ursodiol in combination with licorice extract has helped normalize transaminase levels in hepatitis C patients who are resistant to interferon (Tsubota A et al 1999).
In an earlier study, researchers tested 91 patients (47 males and 44 females) with chronic hepatitis C liver disease. Patients were randomly assigned to receive ursodiol (450 mg) at bedtime for six months (44 patients) or no treatment (47 patients). No relevant side effects were reported. Researchers found that ursodiol was able to significantly reduce serum ALT and gamma-glutamyltransferase (GGT) levels. These results led researchers to hypothesize that ursodiol might be an alternative for patients who do not respond to interferon or who relapse once interferon is discontinued (Puoti C et al 1993).
Polyenylphosphatidylcholine. Polyenylphosphatidylcholine (PPC) is a naturally occurring phospholipid found throughout the body, particularly in cell membranes. It has been demonstrated that orally administered PPC can be incorporated into the liver cell membrane to enhance its integrity. PPC assists the cell membrane in determining what is safe to enter the cell as nutrients and what should be hampered from entry, such as toxins. Hepatocytes (liver cells) are prime examples of cells needing the protection of a vigilant cell membrane (Oneta CM et al 1999). In patients with hepatitis C and in animal models of hepatitis, PPC has been shown to reduce levels of liver enzymes (Lieber CS 2004).
Evidence of disease activity was also significantly reduced in chronic active hepatitis patients on phospholipid therapy (Holoman J et al 1998). Liver cell regeneration was greater in those receiving PPC. Because of its multifaceted nature, orally administered PPC, a constituent of lecithin, may have the potential of arresting and reversing liver damage (Abakumova OI et al 1996).
PPC can also enhance the bioavailability of various herbs, drugs, and nutrients, including silibinin, vitamin E, and interferon (Werner C et al 1990; Reizis AR et al 1992).
When PPC is administered in conjunction with interferon, there is an increase in both their therapeutic values. In one study, patients with hepatitis C were given interferon (3 million IU, three times a week for 24 weeks) and either placebo or PPC (1.8 g daily). Researchers measured ALT levels and defined a response as a reduction of at least 50 percent. They found 71 percent of study participants taking PPC experienced a 50 percent drop in ALT, compared to 51 percent on placebo (Niederau C et al 1998).
In another study, a complex of silymarin (milk thistle) and PPC was given to people with chronic active hepatitis. After seven days, 20 patients observed decreases in AST, ALT, and GGT. In addition, bilirubin and alkaline phosphatase levels dropped.
Selenium. Numerous studies have documented low levels of selenium in hepatitis C patients, and when used in conjunction with other antioxidants, it has been shown to reduce oxidative stress in the liver. The level of selenium depletion appears to correspond to disease severity: the more advanced the liver damage, the greater the degree of depletion. One study found that cirrhotic hepatitis C patients had significantly lower levels of selenium, glutathione, and vitamins A, C, and E than noncirrhotic patients and that all hepatitis C patients had lower levels of these antioxidants than age-matched healthy controls (Jain SK et al 2002). Another study examined untreated hepatitis C patients and found that levels of selenium and zinc were significantly reduced and overall antioxidant status was lower in hepatitis C patients than in healthy controls (Ko WS et al 2005).
Hepatitis C
Boosting Liver Glutathione Levels
Glutathione is the most important antioxidant used and manufactured by the liver. It kills bacterial invaders, acts as a cellular detoxifier, and helps prevent damage from free radicals. In patients with hepatitis C, particularly those who are HIV positive, a systemic depletion of glutathione is observed, especially in the liver. This depletion may be a factor underlying the resistance to interferon therapy and a biological basis for supplementing with the following nutrients that raise glutathione levels (Moriya K et al 2001):
N-acetyl-cysteine. N-acetyl-cysteine (NAC) is derived from L-cysteine, a conditionally essential amino acid. NAC is more efficiently absorbed and also acts as an antioxidant.
S-adenosyl-L-methionine. S-adenosyl-L-methionine (SAMe) is an effective antidepressant that also helps regenerate normal liver function by increasing glutathione levels and decreasing the activity of free radicals. It is one of the most important liver-protecting substances in the body.
Lipoic acid. This acid is used by almost every tissue in the body as a free-radical fighter. It also helps regenerate other essential antioxidants and acts as a metal chelator.
Whey protein isolate. This protein boosts glutathione levels and improves the functioning of the immune system. The fact that hepatitis C often becomes active in people after they reach the age of 40 indicates that age-associated immune decline plays an important role in the progression of the disease.
Reducing Damage from Free Radicals
In addition to supplements that boost glutathione, broad-spectrum antioxidant supplementation will help protect the liver against damage from free radicals. Recent trials have examined hepatitis C therapy with various antioxidants, including glycyrrhizin (from licorice extract), silymarin, vitamin C, lipoic acid, glutathione, and vitamin E. One study, which enrolled 50 hepatitis C patients, assigned patients randomly to one of these antioxidant groups for 20 weeks of treatment. Antioxidant therapy resulted in favorable scores for liver enzyme levels, virus RNA levels, or liver biopsy scores in almost half the patients. Normalization of liver enzymes occurred in 44 percent of patients who had elevated ALT levels before treatment. The treatment was well tolerated among all patients, leading the authors to conclude that multi-antioxidative treatment was beneficial in hepatitis C (Melhem A et al 2005).
In another study, a combination therapy of vitamin C and vitamin E was tested for its ability to protect the ratio of anti-inflammatory eicosapentaenoic acid (EPA) to pro-inflammatory arachidonic acid. Researchers found that these two vitamins protected EPA in the liver of people who were on combination interferon/ribavirin therapy, which suggested that these antioxidants might help boost the effectiveness of combination therapy (Murakami Y et al 2006).
Finally, in a study of patients who were candidates for liver transplant because of severe complications of hepatitis C, a research team examined the effectiveness of a combination treatment of lipoic acid, silymarin, and selenium. These nutrients were chosen because they protect the liver from oxidative damage, boost the levels of other antioxidants, and interfere with viral replication. At the end of the study, none of the three patients followed had undergone liver transplant. Instead, they had “recovered quickly and their laboratory values remarkably improved†(Berkson BM 1999).
Liver-Protecting Nutrients
Silymarin and its chief active ingredient, silibinin, are derived from milk thistle, a member of the daisy family. Both substances help prevent toxic liver damage and help the liver regenerate after damage. Silymarin and silibinin actually accelerate the rate of protein synthesis in the liver, leading to faster cell regeneration (Sonnenbichler J et al 1984, 1986a, 1986b; Valenzuela A et al 1994). Silymarin has produced a reduction of liver enzyme levels in hepatitis C patients (Mayer KE et al 2005).
Some clinicians have found that a combination of silymarin and silibinin, PPC, SAMe, selenium, and several glutathione-boosting supplements not only improves outcomes of hepatitis C patients who are treated, but because it produces fewer side effects than conventional antiviral therapy (interferon and ribavirin), also decreases the patient dropout rate.
Long-term use of licorice root extract (glycyrrhizin) has been shown to be helpful in preventing inflammation, liver cirrhosis, and hepatocellular carcinoma in Japanese hepatitis C patients (Guyton KZ et al 2002; Kumada H 2002). However, licorice flavoring is not effective. A possible side effect associated with ingestion of large amounts of licorice is hypertension. Therefore, blood pressure should be monitored regularly if one is taking licorice root.
Reducing Iron Stores
Elevated serum iron levels are often found in people with hepatitis C and cause further oxidative damage to the liver. Certain nutritional supplements have shown evidence of reducing serum iron levels. To help keep serum iron levels in the low normal range of 30 to 80 ng/dL, high doses of green tea polyphenols and high-allicin garlic may be beneficial.
Lactoferrin, a subfraction of whey protein, may be especially beneficial as an adjunctive treatment for serum iron overload in hepatitis patients. Lactoferrin is a potent antioxidant, antiviral agent, and scavenger of free iron. In addition, lactoferrin is directly involved in the upregulation of natural killer cell activity, making it a natural modulator of immune function (Yi M et al 1997; Ikeda M et al 1998, 2000). As an immune booster, lactoferrin has been shown to work synergistically with interferon to reduce the viral load (Ishii K et al 2003).
Taking 300 mg of elemental calcium can reduce iron absorption by as much as 50 percent. When eating iron-rich foods, hepatitis C patients should consider taking a high-potency calcium supplement at the same time (Hallberg L et al 1991).
Life Extension Foundation Recommendations
Some herbs are metabolized in the liver and can be toxic to it, especially in high doses. The following herbal products have demonstrated liver toxicity: germander, comfrey, chaparral leaf, ma huang, pennyroyal, skullcap, and mistletoe. If one desires to use any of these herbal products, it is advisable to do so under the care of a physician and with careful monitoring of liver enzymes and hepatitis C viral counts (Harvey J et al 1981; Gossrau R et al 1990).
Hepatitis C latches on to iron to inflict free-radical damage on liver cells. One way of reducing these toxic free radicals is to lower the amount of iron in the liver. Serum iron levels should be maintained at the lowest possible tolerable levels (ideally below 60 mcg/dL of blood), and serum ferritin levels should be maintained in the low normal range of 30 to 80 ng/dL.
Another way of protecting the liver is to consume the proper antioxidant nutrients to protect cells against the damaging effects of free radicals. A healthy immune system may keep hepatitis C in check. Supplements that help maintain youthful immune function are of particular importance.
The following supplements have been shown to reduce liver oxidative damage, lower iron, and boost the effectiveness of conventional drugs:
Calcium citrateâ€â€1000 to 2000 milligrams (mg) daily with iron-containing foods to block iron absorption
Lactoferrinâ€â€900 mg daily, to block iron, in divided doses
Lipoic acidâ€â€750 mg in three divided doses daily
NACâ€â€600 mg daily
Whey protein isolateâ€â€20 to 40 grams (g) daily
Glutathioneâ€â€500 mg daily, on an empty stomach
Silibinin extractâ€â€900 mg daily, in two divided doses
SAMeâ€â€1200 mg daily, in three divided doses
PPCâ€â€1800 to 3600 mg daily
Green tea extract (93 percent polyphenols)â€â€750 mg daily
Garlic (high allicin)â€â€900 mg daily
Aged garlic extract (Kyolic®)â€â€1200 mg daily
Seleniumâ€â€200 to 600 micrograms (mcg) daily
Vitamin Eâ€â€400 international units (IU) daily with at least 200 mg gamma tocopherol
Vitamin Câ€â€2000 mg daily (on an empty stomach to minimize the increased iron absorption caused by vitamin C)
Hepatitis C Safety Caveats
An aggressive program of dietary supplementation should not be launched without the supervision of a qualified physician. Several of the nutrients suggested in this protocol may have adverse effects. These include:
Calcium
Do not take calcium if you have hypercalcemia.
Do not take calcium if you form calcium-containing kidney stones.
Ingesting calcium without food can increase the risk of kidney stones in women and possibly men.
Calcium can cause gastrointestinal symptoms such as constipation, bloating, gas, and flatulence.
Large doses of calcium carbonate (12 grams or more daily or 5 grams or more of elemental calcium daily) can cause milk-alkali syndrome, nephrocalcinosis, or renal insufficiency.
Garlic
Garlic has blood-thinning, anticlotting properties.
Discontinue using garlic before any surgical procedure.
Garlic can cause headache, muscle pain, fatigue, vertigo, watery eyes, asthma, and gastrointestinal symptoms such as nausea and diarrhea.
Ingesting large amounts of garlic can cause bad breath and body odor.
Green Tea
Consult your doctor before taking green tea extract if you take aspirin or warfarin (Coumadin). Taking green tea extract and aspirin or warfarin can increase the risk of bleeding.
Discontinue using green tea extract 2 weeks before any surgical procedure. Green tea extract may decrease platelet aggregation.
Green tea extract contains caffeine, which may produce a variety of symptoms including restlessness, nausea, headache, muscle tension, sleep disturbances, and rapid heartbeat.
Lipoic Acid
Consult your doctor before taking lipoic acid if you have diabetes and glucose intolerance. Monitor your blood glucose level frequently. Lipoic acid may lower blood glucose levels.
NAC
NAC clearance is reduced in people who have chronic liver disease.
Do not take NAC if you have a history of kidney stones (particularly cystine stones).
NAC can produce a false-positive result in the nitroprusside test for ketone bodies used to detect diabetes.
Consult your doctor before taking NAC if you have a history of peptic ulcer disease. Mucolytic agents may disrupt the gastric mucosal barrier.
NAC can cause headache (especially when used along with nitrates) and gastrointestinal symptoms such as nausea and diarrhea.
Milk Thistle
Consult your doctor before taking milk thistle with tranquilizers such as Haldol, Serentil, Stelazine, and Thorazine. Milk thistle combats the effect of tranquilizers.
Do not combine milk thistle with the blood pressure medication Regitine. Milk thistle combats the effect of Regitine.
Phosphatidylcholine
Phosphatidylcholine can cause increased salivation, a metallic taste, headache, drowsiness, and gastrointestinal symptoms such as nausea and diarrhea.
SAMe
Consult your doctor before taking SAMe if you have bipolar disorder. See your doctor frequently if you take SAMe and you have bipolar disorder.
Consult your doctor before taking SAMe if you take antidepressants. See your doctor frequently if you take SAMe in place of or in addition to antidepressants.
Consult your doctor before taking SAMe if you have cancer. Nucleic acid methylation patterns may change in people who have cancer and take SAMe.
Do not take SAMe if you are undergoing gene therapy.
SAMe can cause anxiety, hyperactive muscle movement, insomnia, hypomania, and gastrointestinal symptoms such as nausea and diarrhea.
Selenium
High doses of selenium (1000 micrograms or more daily) for prolonged periods may cause adverse reactions.
High doses of selenium taken for prolonged periods may cause chronic selenium poisoning. Symptoms include loss of hair and nails or brittle hair and nails.
Selenium can cause rash, breath that smells like garlic, fatigue, irritability, and nausea and vomiting.
Vitamin C
Do not take vitamin C if you have a history of kidney stones or of kidney insufficiency (defined as having a serum creatine level greater than 2 milligrams per deciliter and/or a creatinine clearance less than 30 milliliters per minute.
Consult your doctor before taking large amounts of vitamin C if you have hemochromatosis, thalassemia, sideroblastic anemia, sickle cell anemia, or erythrocyte glucose-6-phosphate dehydrogenase (G6PD) deficiency. You can experience iron overload if you have one of these conditions and use large amounts of vitamin C.
Vitamin E
Consult your doctor before taking vitamin E if you take warfarin (Coumadin).
Consult your doctor before taking high doses of vitamin E if you have a vitamin K deficiency or a history of liver failure.
Consult your doctor before taking vitamin E if you have a history of any bleeding disorder such as peptic ulcers, hemorrhagic stroke, or hemophilia.
Discontinue using vitamin E 1 month before any surgical procedure.
For more information