Hepatitis: Overview, Symptoms and Treatment

The liver is the largest internal organ, and one of the most complex. It regulates the amount of sugar, fat, and protein that circulate in your blood. It makes cholesterol, vitamin A, clotting factors, and about a quart of bile a day, which helps digest fats. And it detoxifies your blood, removing drugs, alcohol, and other potentially harmful chemicals so you can eliminate them.

A key compound your liver filters from blood is bilirubin, a breakdown product of old red blood cells. When your liver is healthy, it processes bilirubin, and adds it to bile, which enters the small intestine on its way to elimination. But if your liver is damaged and can’t filter properly, bilirubin builds up in your blood and eventually gets deposited in your skin and eyeballs, turning them yellow. That’s jaundice, a classic sign of liver disease.

Your liver usually purrs along, quietly performing its many critical tasks despite all the noxious drugs and alcohol you send its way. But your liver can also get infected by several viruses. That’s hepatitis. There are six types of viral hepatitis: A, B, C, D, E, and G. But the three main ones are A, B, and C.

Hepatitis A

The bad news is that hepatitis A is the most common viral liver infection in the U.S. The good news is that, in the vast majority of cases, within two months, you heal completely. Hepatitis A spreads through contaminated food or water. Two to three weeks after you get infected, you develop jaundice along with flu-like symptoms, and your urine turns dark because some bile mixes with it.

Hepatitis A is a hazard of travel to areas with poor sanitation. In the U.S., it’s common in daycare center children and staff, and in children age five to 14.

Hepatitis A does not cause cirrhosis, nor does it become chronic.

Hepatitis B

Hepatitis B causes the same symptoms as hepatitis A, but it can last longer, and cause more damage including cirrhosis and liver cancer.

Hepatitis B spreads by blood-to-blood or sexual contact. It’s a major occupational hazard of nurses and other health workers who accidentally get stuck by needles containing contaminated blood. Pregnant women can pass the infection to their babies. And some people are carriers–they don’t develop symptoms, but they’re infected and can spread the disease through blood-to-blood or sexual contact.

About 300,000 cases of hepatitis B are diagnosed each year, and 10 percent of those people become chronic carriers. The younger you are when diagnosed with hepatitis B, the greater your risk of chronic infection. Chronic hepatitis may cause no symptoms. Or you might experience fatigue, loss of appetite, nausea, vomiting, fever, and recurring jaundice. Around 20 percent of people who have had hepatitis B die prematurely from cirrhosis or liver cancer.

Hepatitis C

Only about 10 percent of people infected with hepatitis C develop typical hepatitis symptoms, but an estimated 85 percent become carriers. Within 10 years of infection, about 25 percent of those who have had hepatitis C develop cirrhosis and 10 percent develop liver cancer.

The National Institutes of Health estimates that 4 million Americans now have hepatitis C. An estimated 170,000 new cases are diagnosed each year. And some 9,000 Americans die annually from cirrhosis caused by it. To make matters worse, like AIDS, hepatitis C may not cause symptoms for many years after infection. Today, an estimated 1 million Americans are symptom-free carriers who can spread the infection.

Like hepatitis B, hepatitis C spreads by blood-to-blood contact and sexually.

Immunization Against Hepatitis

• Get the shots. “The best treatment for hepatitis A and B is prevention,” notes family practitioner Belinda Vail, M.D., of the University of Kansas School of Medicine in Kansas City. If you plan to travel abroad, ask your doctor about hepatitis A vaccination. Ask for the three-shot hepatitis B vaccination if you’re planning to travel to areas with high rates of it (China, Southeast Asian, sub-Saharan Africa, South America, and the South Pacific), or if you’re in a high-risk group: a health worker, a sex partner of anyone infected, a person on kidney dialysis, a male homosexual, or an intravenous drug user. In addition, most states now require school children to be vaccinated.

Hepatitis and Lifestyle Choices

• Limit your liquor. Alcohol is a leading cause of liver damage. Thelma Thiel, R.N., former president of the American Liver Foundation in Cedar Grove, New Jersey, says: Don’t have more than one or two drinks a day. (A “drink” is one 12-ounce beer, or a cocktail with 1.25 ounces of 80-proof liquor, or four ounces of wine, the typical wineglass about half full.)

• Don’t mix drugs and alcohol. Many drugs stress the liver: antibiotics, steroids, estrogen, diabetes medications, anti-inflammatories, even acetaminophen (Tylenol). Take them if you have to (and consider taking milk thistle as well–see “Herbal Medicine” below), but watch the alcohol. The combination of drugs and alcohol can raise your risk of liver damage considerably, Thiel says.

Herbal Medicine

• Milk thistle to the rescue. Noted pharmacognosist (natural product pharmacist) Varro Tyler, Ph.D., former dean of the School of Pharmacy at Purdue, says studies “have shown conclusively” that milk thistle helps protect your liver. Commission E, the German expert panel that judges the safety and effectiveness of herbal medicines for that nation’s counterpart of the Food and Drug Administration, endorses milk thistle as a treatment for hepatitis.

Milk thistle is a weed that grows throughout the temperate world. Traditionally, herbalists used it to treat liver problems, which led pharmacologists to investigate it. In 1968, German researchers isolated three liver-protective compounds from milk thistle seeds—silibinin, silidianin, and silicristin—collectively known as “silymarin.”

Milk thistle helps the liver in three ways: It spurs repair of damaged liver cells. It binds tightly to the receptors on liver cell membranes that allow toxins in, thus locking them out. And its powerful antioxidant action helps protect liver cells from damage by dangerously reactive oxygen ions (free radicals).

Tea made from milk thistle seeds doesn’t contain enough silymarin to do much good. So German plant scientists bred a high-silymarin variety, that produces a standardized extract. A 200 mg dose of this extract contains 140 mg of silymarin. In all the studies of silymarin, the standard dose is 140 mg. of this extract three or four times a day.

Silymarin clearly helps treat hepatitis, says Alan Brauer, M.D., founder of TotalCare Medical Center in Palo Alto, California, one of the nation’s first clinics to combine mainstream and complementary therapies. German researchers gave viral hepatitis sufferers either a placebo or silymarin. After three weeks, significantly more of the silymarin group showed normal liver function. Several other European studies have shown that compared with hepatitis sufferers who did not receive silymarin, those who did recovered more quickly.

As an added bonus, silymarin is remarkably safe. If you use it, chances are you’ll experience no side effects, though you might develop an upset stomach or an allergic reaction. Silymarin is sold over the counter at most health food stores. Look for the standardized extract.

• Catch some catechin. Catechin is a component of the Southeast Asian herb, pale catechu (Uncaria gambier). It’s a potent antioxidant that helps stimulate the immune system. “In several double-blind studies,” says naturopath Joseph Pizzorno, N.D., president of Bastyr University, the naturopathic medical school near Seattle, catechin has been shown to decrease blood levels of bilirubin in people with all types of hepatitis. It also speeds relief of hepatitis symptoms.” In one study, 338 people with chronic hepatitis B were given either a placebo or 1.5 g a day of catechin for two weeks followed by 2.5 g a day for another two weeks. After the month, 15 percent of the placebo group showed significant improvement, while among the catechin users, the figure was twice as high–31 percent. Dr. Pizzorno suggests 1 g three times a day. Catechin is available at many health foods stores and from naturopaths.

• Lick it with licorice. Licorice root has both antiviral and anti-inflammatory action, Dr. Pizzorno says. Several studies show that when injected, it helps treat hepatitis. One Indian study investigated liver failure due to chronic hepatitis. If left untreated, this condition has a survival rate of only about 30 percent. The researchers treated 18 people with intravenous licorice extract (40 or 100 ml a day for 30 days). Their survival rate more than doubled–to 72 percent. Because licorice must be injected, this treatment cannot be used at home. Consult a naturopath.

Supplements

• Boost your antioxidants. Antioxidant nutrients “are essential in protecting liver cells from damage,” says Dr. Pizzorno, which is part of the reason why antioxidant milk thistle is so beneficial. A key antioxidant is the mineral, selenium. Chinese researchers fortified table salt with 15 parts per million of selenium and gave it to the 21,000 people in one town in Jiangsu, a province with a high rate of hepatitis B infection. Prior to this study and during the first year of follow-up, the test town and six surrounding towns had virtually identical rates of hepatitis B. But by the second year, the people who used the selenium-treated salt showed a 59 percent reduction in hepatitis infection. Dr. Pizzorno recommends obtaining selenium from a multi-vitamin-mineral insurance formula.

Another noted antioxidant is vitamin E. Italian researchers recruited 24 people with hepatitis B, most of whom had not benefited from interferon (see “…And Finally” below). They took either a placebo or vitamin E (600 mg/day) for three months, and were tracked for six more. After nine months, 17 percent of the controls showed no evidence of infection. In the vitamin E group, the figure was 58 percent. Vitamin E is available in insurance and antioxidant formulas, though to obtain the dose used in this study, you’d have to take an supplement containing just vitamin E.

Dr. Pizzorno also recommends large doses of another antioxidant, vitamin C (10 g a day).

• Go for glutathione. Glutathione is a powerful antioxidant protein that helps maintain a healthy liver. “In my experience,” Dr. Brauer says, “it a good treatment for hepatitis.” He prescribes 800 mg a day. Glutathione is available at health food stores.

Chinese Medicine

• Dry and cool damp Heat. Chinese medicine views hepatitis as an invasion of dampness and Heat in the liver, which stagnates chi, according to San Francisco Chinese physician Efrem Korngold, L.Ac., O.M.D., co-author (with Harriet Beinfield, L.Ac.) of Between Heaven and Earth: A Guide to Chinese Medicine. He recommends avoiding all fats, and eating bitter greens and easily digested foods that are high in protein, among them: spinach, chard, chicory, beets, and Chinese lycii berries.

In addition, he prescribes a seven-herb formula called Xiao Chai Hu Tang, which is revered in China as powerful liver medicine. Its ingredients are anti-inflammatory and antiviral, including: bupleurum root, jujube fruit, half summer root, licorice, ginger, ginseng, and Chinese skullcap root.

In Japan, this same formula is called shosaikoto. Japanese researchers gave either a placebo or shosaikoto to 222 people with chronic hepatitis B. Only the shosaikoto group’s liver function improved significantly. When children with chronic hepatitis B are left untreated, about one-quarter become virus-free in six months. In another Japanese study of children treated with shosaikoto, half eliminated the virus.

• Point your way to healing. Dr. Korngold suggests several points. If you’d rather not go to an acupuncturist, you can stimulate the same points with finger acupuressure. Use steady, boring, penetrating pressure on each point for three minutes.

• Liver 3. On top of your foot, in the valley between your big toe and second toe.

• Gall bladder 34. On the outside of your lower leg, below and in front of the head of your shinbone.

• Stomach 36. Four finger widths below your kneecap toward the outside of your shinbone.

• Conception Vessel 12. On your midline, three finger widths below the base of your breastbone in the pit of the upper abdomen.

Ayurvedic Medicine

• Fill up on Phyllanthus. Ayurvedic medicine views hepatitis as a Pitta (fire) condition. Excessive Pitta overheats the liver, resulting in inflammation. Ayurvedic physicians often recommend Chinese bupleurum root for hepatitis. But the traditional Ayurvedic herb for hepatitis is Bhumyamalaki (Phyllanthus niruri). A close relative of this herb, Phyllanthus amarus, was studied by researchers at the University of Madras, India. They gave 60 hepatitis B carriers either a placebo or 200 mg of P. amarus three times a day for 30 days. By the end of the study, only one of the 23 people in the placebo group (4 percent) showed no evidence of infection. But in the herb group, the figure was 22 of 37 (59 percent). To obtain Phyllanthus amarus, ask an Ayurvedic physician or a naturopath.

Other Good Choices

Diet

• Delight in dandelion. Gardeners hate dandelions. But since the Middle Ages, herbalists have revered the weed as a liver remedy because its yellow flowers were considered a sign from God that dandelion could treat yellowing of the skin caused by jaundice. This medical philosophy, called the Doctrine of Signatures, sounds ridiculous today, but sometimes the wrong reason can still come up with the right answer. “Animal and human studies show that dandelion enhances the flow of bile, and can help treat hepatitis,” Dr. Pizzorno says. This herb is also richer in antioxidant vitamin A than carrots. One hundred grams of carrots give you 11,000 IU of vitamin A. With dandelion, 100 g of greens or flowers give you 14,000 IU.

“Dandelion greens taste bitter,” says Maryland botanist/herbalist James Duke, Ph.D., author of The Green Pharmacy. “Add them to salads if you like, but when I weed my garden, I save the leaves and flowers and steam them like spinach. Steamed dandelions are not as bitter and they’re delicious.”

Homeopathy

• Try microdose medicines. Berkeley, California, homeopath Dana Ullman, M.P.H., author of The Consumer’s Guide to Homeopathy, suggests the following medicines for hepatitis: Aconite (monkshood), Belladonna (deadly nightshade), Chelidonium (greater celandine), Lycopodium (club moss), Mercurius (mercury), and Nux vomica (poison nut).

And Finally…

Until recently, the only mainstream treatments for hepatitis were rest and avoidance of drugs and alcohol. Now there’s interferon alpha. It’s no sure cure–only about half of those who take is respond. It’s also very expensive, up to $10,000 a year. And it causes many unpleasant side effects: flu-like symptoms rashes, depression, and thyroid disorders.

Recently, Pennsylvania State University researchers discovered that people with hepatitis C who do not respond to interferon may benefit from the antiviral flu drug, amantadine (Symmetrel). Doctors also hope that the new antiviral drugs developed to combat AIDS may also help treat hepatitis.

Liver transplantation is your last resort. But the supply of livers is limited. This surgery is very traumatic and expensive. And one person in five develops cirrhosis after receiving a transplant.