Natural Alternatives to Hepatitis C

Continued from Part 2

* Iron reduction

Dr. Bonkovsky's paper for the NIH (referred to earlier) contains a section

on Iron Reduction. Among other things, it says:

"Hayashi and colleagues(5) reported that iron reduction alone, by repeated

venesection [drawing of blood], led to significant improvement in serum

alanine aminotransferase (ALT) levels in chronic hepatitis C. Indeed, the

levels became normal in 5 of 10 subjects studied. This was confirmed in 12

additional studies involving a total of 306 patients. (2) In addition, in

some, iron reduction alone led to a modest, albeit usually not

statistically significant, decrease in serum levels of HCV RNA. Addition of

IFN after iron reduction led to further and larger decreases in serum HCV

RNA levels and to significant improvement in biochemical and virological

responses. Of particular interest is a recent study in which previously

untreated patients received IFN alone or IFN after iron reduction. A total

of 29 percent (6/21 ) of the former but 59 percent (10/17) of the latter

had a complete biochemical response, and this was sustained in 29 percent

(5/17) versus 5 percent (1/21) for more than 6 months after therapy was

discontinued. Clearly, these results need confirmation in a large

multicenter trial."

Should this lead us to focus some effort on minimising iron in the diet of

people with chronic hepatitis C? Is so, what is a simple way to do that -

what foods should be reduced or eliminated? The American Liver Foundation

suggests that people with excessive iron levels avoid iron cooking

utensils, among other things. Or should people with hepatitis C even have

blood drawn regularly to keep iron levels low?

* Licorice root (Glycyrrhiza glabra)

Licorice root contains glycyrrhizin, which is extensively used in Japan for

hepatitis patients, and is clearly worth considering.

In all the reported clinical trials, it has been administered intravenously

in the form of a preparation (Stronger Neo-minophagen C, or SNMC),

consisting of 0.2 per cent glycyrrhizin, 0.1 per cent cysteine and 2.0 per

cent glycine in physiological saline solution.

Licorice root has long been used in traditional Chinese medicine as a

remedy for jaundice. The attached article on "Phytogenic agents in the

therapy of liver disease" by Thabrew and Hughes summarizes a number of

clinical studies that have been done with glycyrrhizin on hepatitis in

recent years.

Glycyrrhizin has been shown in vitro to have direct inhibitory effects on

the viruses HAV and HBV. (I assume there are no comparable studies on HCV

because it has proved difficult to culture the virus.) Several clinical

trials in Japan have shown that it can improve liver function in patients

with chronic hepatitis and cirrhosis. It accelerated seroconversion in one

study with hepatitis B patients.

Animal experiments and in vitro experiments with human peripheral

lymphocytes have shown that glycyrrhizin enhances interferon production. A

trial in Japan improved response to interferon treatment among patients

with hepatitis B by giving them a short course of glycyrrhizin before

starting interferon treatment.

Thabrew and Hughes conclude their review of phytotherapy for liver disease

saying: "For chronic viral hepatitis, glycyrrhizin appears to be the most

beneficial agent for the following reasons: it can achieve improvements in

liver function and an inhibition of viral activity in a shorter time period

and it enhances interferon production and can also be used to supplement

interferon treatment of patients with chronic hepatitis B."

With regard to side effects, Thabrew and Hughes report that long term use

of large doses of glycyrrhizin has been associated with

pseudo-aldosteronism. Not knowing what that is, I am unable to form an

opinion about it. One contributor to an Internet conference says of

glycyrrhizin: "Non toxic but in extended use or at high doses can cause

potassium depletion in some people which can cause serious side effects."

This might suggest that one should eat plenty of banana or melon, or take

potassium supplements, if using licorice root. One book I have read

commented that bilirubin levels may rise with the use of licorice. I have

also read that use of high doses can lead to headaches or hypertension.

Daniel B. Mowrey, Director of the American Phytotherapy Research Laboratory

in Salt Lake City, says: "About 20% of the population is sensitive to the

effects of ingesting high amounts of licorice extract. As a general

cautionary measure, persons with a history of hypertension, or renal

failure, or who are currently taking cardiac glycosides, may wish to avoid

the use of licorice root."

Licorice may also have an anti-inflammatory effect, and is sometimes used

against both asthma and arthritis.

The "Encyclopedia of Natural Medicine," by Michael Murray, N.D. and Joseph

Pizzorno, N.D. says:

"The recommended dosage of Liquorice (Glycyrrhiza glabra) for hepatitis of

all kinds is:

(Doses 3 times per day)

Dried root (or as tea), 1 to 2 g.

Tincture (1:5), 4-6ml (1 to 1.5 tsp)

Fluid extract (1:1), 0.5-2.0 ml (1/4 to 1/2 tsp) Powdered solid extract

(4:1), 250-500 mg

"If liquorice is used over a long time it is necessary to increase the

intake of potassium rich foods...

"The other components of SNMC, glycine and cysteine, appear to modulate

glycyrrhizin's actions. Glycine has been shown to prevent the sodium- and

water-retaining effects of glycyrrhizin, while cysteine aids in

detoxification via increased glutathione synthesis and cystine[sic]

conjugation."

A study reported in 1997 found that among 27 chronic hepatitis C patients

given 60 mi of Stronger Neo-Minophagen C three times a week for 16 weeks,

74% saw their ALT levels reduce to half of the starting level, without any

change in their viral load. Another recent Japanese study of 193 hepatitis

C patients found that those who received long-term treatment with Stronger

Neo-Minophagen C had half the rate of liver cancer over 15 years than those

not treated.

* Mushrooms, other

I have already summarized my reasons for using the shiitake mushroom, a

proven immunostimulant. There are also other mushrooms which are no doubt

of interest, which I have not yet had time to research extensively. They

include the maitake mushroom (Grifola frondosa), the reishi mushroom

(Ganoderma), and Coriolus versicolor.

Japanese researchers have found the maitake to be one of the most powerful

mushrooms for anti-cancer and immune-enhancing effects. Maitake extracts

have shown activity against HIV and hepatitis. Maitake has been used

effectively in combination with chemotherapy. It is believed to be an

interferon inducer.

Maitake mushrooms are apparently becoming popular in Italy as an ingredient

for pasta sauce, which hopefully suggests that they are safely non-toxic.

Dr. Weil recommends maitake supplements to people with chronic hepatitis,

as well as to patients with chronic fatigue syndrome, cancer and AIDS,

among other illnesses.

A summary on the Internet on the Reishi mushroom says:

"Chinese herbalists prize it for its abilities to regenerate the liver. In

high doses, and to some degree normal doses, Ganoderma maybe classified as

a liver detoxicant and protectant.

"Toxicity studies show no toxic effects on humans. In research, patients

are given much higher doses, as high as 10 grams of extract per day, with

no ill effects.

"The mycelium of Reishi contains high levels of polysaccharides, which have

been shown in research to induce the production of interferon. Interferon

is a protein produced inside cells to fight viral infection.

Polysaccharides are also tumor fighters and help stimulate the immune

system.

"Reishi is being recognized for its adjunct use as an immune system

stimulator when cancer therapy is being used. The use of Reishi as a cancer

treatment in the Orient is centuries old. In following the concept of qi

tonics, Reishi is used to strengthen the body's resistance to outside

forces.

"Former heart surgeon Dr. Fukumi Morishige, a leading authority on vitamin

C in Japan, reports that when Reishi and vitamin C are combined the results

against cancer and other diseases are far better than when Reishi is

ingested. This is because the vitamin makes the polysaccharides more

accessible to the immune system."

Coriolus versicolor is another mushroom which appears to have strong

immunostimulant properties, and which is recommended for hepatitis by at

least one manufacturer. It too is used widely in Japan as an anti-cancer

agent. A paper on it is included in Other Papers.

* Phyllanthus amarus

Phyllanthus has traditionally been used in Indian ayurvedic medicine for

hepatitis. A quick glance at the clinical research shows contradictory

results. Some studies (a number are mentioned in the attached article by

Thabrew and Hughes) have suggested that it improves liver function in

patients with chronic hepatitis (especially hepatitis B), other studies

suggest that it is no better than a placebo. It does appear to have

anti-viral properties against HBV and perhaps HIV.

I have seen no reports of trials specifically on hepatitis C.

In his "Hepatitis C Handbook" Matthew Dolan warns that this herb can be

toxic, and should only be used under the supervision of a professional

herbalist. This, and the questions about its effectiveness, make me

hesitate.

* Ursodeoxycholic acid (UDCA)

Dr. Bonkovsky again, in his paper for the NIH consensus conference on

hepatitis C:

"Hydrophilic Bile Salts

Supplemental (tauro-) ursodeoxycholic acid has led to improvements in serum

ALT levels, in both the absence and the presence of IFN. (7) These effects

seem to be related to the beneficent effect of hydrophilic bile salts on

many chronic inflammatory conditions involving the liver."

A number of studies appear to have found that UDCA is effective in reducing

ALT levels in hepatitis C patients, without side effects. It does not

appear to affect the amount of virus in the blood. One such study,

carried out in Japan, was reported in 1994 by Takano et. al.: "A

multicenter randomized controlled dose study of ursodeoxycholic acid for

chronic hepatitis C." (Hepatology 1994 ;20: 558-64.)

The following extract from EMBASE may cast some doubt on this, however:

Title

Cytoprotection in the nineties: Experience with ursodeoxycholic acid

and silymarin in chronic liver disease

Author

Lirussi F.; Okolicsanyi L.

Address

Institute of Internal Medicine, University of Padua, Via Giustiniani,

2, 35100 Padova, Italy

Source

ACTA PHYSIOL. HUNG., 80/1-4 (363-367):1992

Abstract

The authors report their experience in the use of ursodeoxycholic acid

and silymarin in patients with active cirrhosis of different aetiology.

Both drugs seemed safe and ameliorated the biochemical indices of

cytolysis; however, the former did not appear to be effective when

hepatic dysfunction was associated to hepatitis C infection. The

residual functional liver mass, as assessed by quantitative liver

function tests, was not affected by either cytoprotective agent.

Language of Publication

English

Unique Identifier

94085703

Though, as is so often the case, the research results may be uneven, if

there are no side effects is there a good reason not to use UDCA?

* Vitamin B complex

B complex vitamins are often prescribed for liver problems. They are said

to support the "cytochrome P450 system", which is involved in the liver's

detoxification process.

In normal doses, the B vitamins appear to have no negative effects in liver

disease. Niacin (Vitamin B3) is considered to be very safe in its form as

niacinamide (up to levels 1,000 times the US Recommended Daily Allowance),

but may be best avoided in its other form as nicotinic acid. In high

doses, nicotinic acid can lead to liver damage.

* Vitamin C

Linus Pauling recommended high doses of vitamin C for hepatitis patients.

It is believed to have anti-viral properties, and to be an interferon

inducer.

One cause for hesitation is that at least one study suggests it may inhibit

the activity of natural killer cells, perhaps in some way as a result of

its antioxidant properties. Natural killer cells may for all we know play

a role in the immune response against HCV.

In my view, a more potent reason to refrain from vitamin C supplements is

that it increases the absorption of iron. As the section above on iron

reduction shows, that is probably one of the last things that a hepatitis C

patient wants to do.

Another vitamin to approach with caution is vitamin A, which I have read

can be toxic to the liver.

* Vitamin E and selenium, other antioxidants

Vitamin E has already been mentioned, as part of the regime I am following.

Patients sometimes combine it with selenium, another antioxidant.

A study in Manitoba, included among the attachments, reports that

liver-damaged rats had less hepatic fibrosis when given selenium and

vitamin E.

Selenium is believed to work with glutathione and appears to be a key

nutrient for maintaining healthy immune function. (Zinc is also believed

to be important for the immune system.)

One question that arises is: should I perhaps be taking supplements of

selenium as well as Vitamin E?

A report on the safety of vitamins and minerals in "Consumers' Research

Magazine" says:

"One of the micro-nutrients, selenium, is an antioxidant by itself, and

also works in conjunction with vitamin E.

Selenium is needed in exceedingly small amounts, measured in micrograms.

Both deficits and excesses of selenium can create health problems, and the

range between too little and too much is narrow. The U.S. RDA for selenium

is only 0.7 mcg daily. Thus, selenium supplementation, if used, needs to be

limited within the safety range. The lowest daily toxic dose of selenium is

unknown at present. Toxicity may be inflicted by continuous intake above

1,000 mcg of selenium daily. Severe toxicity has been reported with

extremely high intakes (20 to 30 mg daily) after only a few weeks.

Excessive selenium can cause extensive tissue damage, especially to those

tissues in which selenium concentrates the most, including skin, nails,

hair, and lungs. It produces a garlic odor in perspiration and breath.

The most toxic forms of selenium are selenite, selenoamino acids, and

selenate. Supplements may be only one of several exposures to selenium.

This micro-nutrient is present in food and water and may be especially high

in these sources from geographic regions where selenium is present

naturally at high levels in the soil."

Is selenium entirely safe at the level contained in a normal supplement, or

is there possibly a slight risk of negative effects associated with

long-term use of supplements if one has a diet that might already supply

plenty of it? And how valuable is it in protecting against hepatitis C?

Interestingly, Dr. Bonkovsky seems to speculate that many other potentially

useful remedies may work partly through their antioxidant action. In his

survey of alternative therapies for the US NIH, he says:

"Antioxidants and Anti-inflammatory Agents:

"Other approaches to treatment, such as the use of N-acetyl cysteine (NAC),

or other GSH donors, are based upon the knowledge that, in chronic

hepatitis C (as in other liver diseases), oxidative stress increases and

plasma and liver GSH concentrations decrease... Favorable effects of

vitamin E (alpha-tocopherol) on oxidative stress and activation of the

cascade of fibrogenesis were reported recently.

"In a few small studies, similar effects have been reported for aspirin,

other nonsteroidal anti-inflammatory drugs, pentoxyfylline, and colchicine.

Similar nonspecific effects probably account for the improvements in serum

ALT levels reported in chronic hepatitis C patients treated with many other

concoctions, including traditional Chinese remedies and extract of snap

cucumber. Whether such improvements in blood tests will be associated with

diminution in the rate of progression to bridging fibrosis, cirrhosis, or

hepatocellular carcinoma is currently unknown but is clearly an important

issue."

* Tibetan yoghurt

While the benefits of ordinary live yoghurt as an immune booster are now

well established, special claims are made for Tibetan yoghurt culture

(kefir), which is being used by some hepatitis C patients. It is believed

to boost immunity, be good for the liver, cleanse the digestive system and

heal inflammation, among many other claims. I have no idea if there has

been any systematic study of it.

Diet

There seems to be wide agreement that diet is important for hepatitis C

patients in maintaining a healthy liver, but less wide agreement on what

the right diet is. Here is what I have been told by one or two

practitioners on the subject, or have read in the literature. I would be

grateful to know if you see anything important that is missing, or that is

in your view incorrect.

* Nuts. One very real dietary concern for hepatitis patients is

aflatoxins. They appear to be among the most toxic chemicals to the liver,

causing necrosis, cirrhosis and liver cancer. They are produced by a

fungus that grows particularly well on nuts, among other foods.

While acute aflatoxicosis due to ingestion of large amounts is rare, the

bigger concern is the long-term effects of very low doses. Epidemiological

studies in Africa and Southeast Asia, where there is a high incidence of

liver cancer, show an association between cancer incidence and the

aflatoxin content of the diet.

The Hepatitis C Handbook suggests that patients might do well to avoid

eating nuts and nut products. Whatever the level of risk (and no one can

assess it with certainty at this stage,) the risk seems worth minimizing,

since hepatitis C patients are already at higher than normal risk of liver

cancer.

I include among the attachments on "Other Herbal Products, etc." an

information sheet on aflatoxins taken from the Internet.

* High-fat food. Avoid eating too much meat or other food rich in animal

fats (with the exception of yoghurt.) Too much fat stresses the liver,

reduces immune response and may even increase the risk of cancer. One meat

meal a day is plenty. Especially avoid deep fried foods.

One recent study found a correlation between fat content in the diet and

severity of cirrhosis. A summary of the study is included under "Other

Herbal Products etc."

* Salt. Don't add salt to your food.

* Minimize eggs, tea, chocolate and sugar. Excessive sugar is believed to

undermine phagocytosis, an important part of the immune response.

* Pain killers. Acetaminophen, the ingredient in Paracetamol and Tylenol,

is a standard hepatotoxic compound used in experiments on liver injury.

Best avoided if possible. Heavy use of aspirin is also not recommended.

Ibuprofen is probably the safest alternative if pain killers are essential,

though it too causes problems if used too much.

* Foods rich in toxic pollution. The foods most heavily contaminated with

pesticides include apples (the worst), carrots, potatoes, lettuce, peaches,

grapes/raisins and strawberries. It is the liver which has to deal with

pesticides entering the body. It is well worth the effort to get organic

varieties of these whenever possible.

By eating lower on the food chain - i.e. minimizing animal products,

emphasising fruit, grains and vegetables, and eating small fish rather than

large - you lessen your intake of pesticides, which concentrate with each

step in the chain.

* Foods considered good for the liver include apple (organic), pear,

beetroot, ginger, cherries, carrots (organic), cucumber, parsley, apricots,

pineapple, radish, chicory, watercress, artichoke, peppermint.

* Protein. There seems to be a fair amount of agreement that hepatitis C

patients should get adequate protein in their diet. Research with

experimental animals has shown that inadequate dietary protein is

associated with hepatic necrosis and fibrosis. Beans, pulses and their

derivatives, such as tofu, are the best source of protein. For the reasons

mentioned above, it is not a good idea to consume large quantities of meat

in order to increase protein consumption.

I look forward to hearing your advice, comments or suggestions.

Attached:

Astragalus selected papers

Bupleurum selected papers

Milk Thistle selected papers

Other herbal products etc. selected papers

Summary of information on:

Thymus

Shiitake mushrooms

Propolis

Echinacea

Yogurt

HepC BC