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).