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.
Medical treatments
Therapy for chronic hepatitis B and C is evolving
and may include interferon (PEG-Intron®, Roferon-A®,
Intron A®, Infergen®), antiviral (Rebetrol®),
and immune-modulating drugs. Autoimmune hepatitis
is usually treated with corticosteroids, such as prednisone
(Deltasone®).
Acute hepatitis generally resolves without medications.
Treatment of chronic hepatitis includes cessation
of causative agents like alcohol. 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.
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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.
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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.
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, as well as in those who
later develop liver cancer from long-standing hepatitis.
Vitamin E levels in the liver may also be decreased
in some people with hepatitis.
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. 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.
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.
However, in children with viral hepatitis, daily injections
of vitamin E (300 IU) for seven days did not produce
any benefit.
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.
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.
(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.
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, 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.
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.
A preliminary trial found 24 grams per day of whey
protein improved blood measures of liver dysfunction
in people with hepatitis B, but not those with hepatitis
C.
