Hepatitis B

Nondrug Therapies to Enhance Liver Function

The value of nutritional therapy in the treatment of chronic hepatitis B infection is consistently overlooked by most physicians, who usually focus on prescribing drugs that suppress the virus. The course of hepatitis B is characterized by chronic liver inflammation and oxidative stress that causes progressive liver damage. This damage results in the formation of scar tissue (fibrosis) within the liver; eventually, severe liver disease may result. Hepatitis B infection is a major cause of liver cancer. Hepatitis B infection can also cause advanced liver failure, leading to liver transplant. In light of these sobering statistics, it’s imperative that all patients with hepatitis B become aware of proven strategies that can reduce inflammation and oxidative stress in the liver, thereby protecting this vital organ from viral damage.

Antioxidant Therapy. As with other diseases related to inflammation and tissue damage, oxidative stress is a key mediator that continues and magnifies the ongoing disease process. The livers of people who have hepatitis show reduced levels of antioxidants, which are consumed in an effort to protect the liver. According to a report in the June 1998 issue of the Journal of Clinical Gastroenterology, investigators showed that nutritional antioxidants are potential therapeutic agents for diseases such as hepatitis. Other investigators reported at the same time that oxidative stress (free-radical damage) is often seen in hepatitis B and may contribute to the emergence of hepatocellular carcinoma, seen in patients after years of chronic liver inflammation. The study stated that antioxidants that down-regulate oxidative damage may be a useful complement to specific antiviral drugs in the therapy of viral diseases.

In a related study, vitamin E (alpha-tocopherol) was reported in a randomized, double-blind, placebo-controlled study to be a successful adjunct approach when combined with alpha-interferon therapy in the treatment of hepatitis because of its strong antioxidant activity (von Herbay A et al 1997).

Selenium. The protective role of selenium against HBV was reported in 1997 in the journal Biological Trace Element Research. The study reported that, in areas of China with high rates of hepatitis B and primary liver cancer, high levels of dietary selenium reduced the incidence of liver cancer and hepatitis B infection. In a 4-year trial of 130,471 people, those who were given selenium-spiked table salt showed a 35.1 percent reduction in primary liver cancer, compared with the group who received salt without selenium. In the same journal report, another clinical study of 226 people who tested positive for hepatitis B showed that taking a 200-mcg tablet a day of selenium reduced the incidence of primary liver cancer to zero. Upon cessation of selenium supplementation, the incidence of primary liver cancer began to rise. The study seems to indicate that taking selenium on a continuous basis is beneficial to people who have viral hepatitis (Yu SY et al 1997).

These human trials have been duplicated in animal studies. The animal studies showed that selenium supplementation reduced hepatitis B infection by 77.2 percent and precancerous liver lesions by 75.8 percent.

Another study in the Journal of Trace Elements and Medical Biology reported the role of trace minerals in diseases such as liver disease and hepatitis. The report indicates that, while there is still some debate regarding the specific role of trace minerals, minerals such as selenium and zinc are of benefit to those who have diseases such as hepatitis (Loguercio C et al 1997).

A 3-year study of 20,847 people investigated whether supplementation with sodium selenite could prevent hepatitis B. The researchers concluded that: "The incidence of virus hepatitis infection in the test population was significantly lower than that of controls provided with no selenium" (Yu SY et al 1989).

Polyunsaturated Phosphatidylcholine (PPC). PPC is a naturally occurring phospholipid, derived from lecithin. It is necessary for maintaining the integrity of cell membranes. Oral PPC is incorporated into the liver cell membrane to improve functioning (such as determining which substances are allowed to enter the liver cell and which are blocked from entry). Adding PPC to interferon (a mainstay of medical treatment for chronic hepatitis B) improves the therapeutic value of interferon. PPC also helps normalize transaminase levels on liver function blood tests.

In patients who have chronic active hepatitis C, phospholipid therapy has been shown to significantly reduce disease activity and help regenerate liver cells. PPC has a history of not only protecting the liver, but also being able to enhance the bioavailability of various herbs and nutrients. The increased power of milk thistle, vitamin E, and interferon when taken along with PPC corroborates this finding. Lessening the liver's effort (regarding detoxifying injurious substances) allows the liver to begin healing.

Milk Thistle (Silybum marinum). Silymarin and its chief active ingredient, silibinin, are derived from milk thistle, a member of the daisy family. Both substances help prevent liver damage and help the liver regenerate faster if damage is done. Silymarin and silibinin actually accelerate the rate of protein synthesis in the liver, leading to faster cell regeneration (Sonnenbichler J et al 1986; Valenzuela A et al 1994). Silymarin and silibinin act in the ribosomes, special cellular organelles where protein synthesis takes place. It was discovered that silibinin can bind to the receptor for an important enzyme called DNA-dependent RNA polymerase. This results in an increase in ribosomal RNA, leading to more protein synthesis. When milk thistle is added to PPC in the treatment of chronic hepatitis B, markers of oxidative stress such as malonaldehyde are decreased.

S-Adenosylmethionine (SAMe). SAMe is the product of a biochemical reaction between adenosine triphosphate (ATP) and methionine. Half of all methionine in the body is used in the liver to make SAMe. SAMe has been compared to ATP in its importance to the body. It is used in many different cellular processes, from replication to biochemical reactions that create melatonin and PPC. SAMe is particularly important for the liver because glutathione, the liver's natural antioxidant, is synthesized from it. Without sufficient glutathione levels in the liver, free-radical damage will occur.

The liver contains the third highest amount of SAMe in the body, after the adrenal and pineal glands. SAMe is so important for liver function that it can be considered an essential nutrient for that organ. It has also been shown to be an effective antidepressant and plays a leading role in liver regeneration.

Glutathione. Glutathione is a potent antioxidant and is necessary for maintaining a normal redox state in the liver, which is vital to hepatic functioning. The following nutrients enhance glutathione levels in the body:

• N-acetylcysteine (NAC). Another substance that improves the response rate to interferon. NAC is necessary for glutathione production and thus decreases oxidative stress.
• Whey protein. Helps boost immune function, protect against free-radical damage, and improve cellular glutathione levels.
• Lipoic acid. A potent antioxidant that helps to increase cellular glutathione levels. In addition, lipoic acid helps to regenerate other essential antioxidants.
• Glutamine. Studies have demonstrated that glutamine supplementation increases glutathione stores in hepatic tissue, which protects liver function.

Avoiding Liver Toxicity

The best diet for people who have hepatitis is chemical free (organic). The Life Extension Foundation suggests that you evacuate your bowels regularly and completely to avoid unnecessarily taxing your immune system and liver. Avoid drinking alcohol. As with all liver disease, you must be certain that you do not have an excessive amount of iron in your body because excessive iron is itself a liver toxin. Measurements of serum iron, total iron-binding capacity, percent saturation, complete blood cell count, blood ferritin, and bone marrow analysis for iron stores may be needed. Discuss how often you should obtain these measurements with your physician. If testing reveals very high serum iron levels, your physician may recommend iron depletion therapy (extracting blood, as in blood donation). Do not undergo iron depletion therapy if you are anemic (anemia is often a consequence of treatment for hepatitis). You should have your iron level closely monitored by your physician.

Certain nutritional supplements have been shown to reduce serum iron levels. To help keep serum iron levels in the normal range (30 to 80 grams per deciliter [g/dL]), high doses of green tea polyphenols and garlic high in allicin may be beneficial. Lactoferrin, a subfraction of whey protein, may be especially beneficial as an adjunctive treatment for serum iron overload in patients who have hepatitis. Lactoferrin is a potent antioxidant, antiviral agent, and scavenger of free iron. In addition, lactoferrin is directly involved in the up-regulation of natural killer cell activity, making it a natural modulator of immune function.

As mentioned earlier, HBV induces free-radical reactions that damage liver cells. A standardized grape-seed extract that provides a high percentage of antioxidant proanthocyanidins can help protect the liver against oxidative stress.

Some herbs can be toxic to the liver, especially in high amounts. The following herbal preparations have been shown to be toxic to the liver: germander, comfrey, chaparral leaf, pennyroyal, skullcap, and mistletoe.

Some patients with hepatitis B take 500 milligrams (mg) of licorice root extract three times a day. There is some controversy about people who have hepatitis B taking high doses of licorice. If you have hepatitis B, the Life Extension Foundation suggests that you take high doses of licorice only under the supervision of a knowledgeable healthcare provider. If you do take high doses of licorice, monitor your blood pressure to guard against any further increase in blood pressure.