Hepatitis

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It is hard to keep everything straight in your mind when talking about hepatitis. Basically, you’ve got a viral invasion of your liver, which stimulates your immune system to grind out antibodies to inactivate the virus. A new infection is termed acute. It feels like the flu, but you can temporarily turn yellow. Doctors have identified six hepatitis viruses–A through G–and each has distinct characteristics. Children and young people, for example, get the milder type A, while grown-ups are more prone to the more severe types B and C. Other types, like D, E, and G are relatively rare by comparison.

Type C is particularly insidious, since the majority of those infected have no symptoms and have no idea how they caught it. I have patients who come in for a checkup feeling fine and walk out with a potentially serious disease. C is also the most common cause of chronic hepatitis.

The course of chronic hepatitis, whether B or C, is unpredictable, but everyone seems to agree that the better patients care for themselves, the less chance they have of developing one of the serious complications.

At WholeHealth Chicago, we think there are many steps you can take to help your body put up a fearsome fight against the virus.

What is Hepatitis?

Hepatitis is an inflammation of the liver that is most often caused by an infection with one of six hepatitis viruses, called hepatitis A, B, C, D, E, and G. All forms of hepatitis inhibit the liver’s ability to carry out its normal functions: secreting fat-digesting bile, processing sugar and carbohydrates, and excreting toxins and wastes.

Viral hepatitis can be either acute or chronic, and in its acute phase, it may cause mild to severe flulike symptoms. Some people with hepatitis also develop jaundice (a yellow tinge to the skin and whites of the eyes). Others have no symptoms at all.

The hepatitis A virus can produce severe symptoms, but usually does no long-term damage to the liver. Most people recover fully and become immune to future hepatitis A infections. Hepatitis B and C, on the other hand, may start out as acute infections, but the resulting liver inflammation can become chronic in some cases and even (rarely) lead to permanent liver scarring (cirrhosis) or liver cancer. Some hepatitis B and C patients become carriers of the disease, with the ability to transmit it to others long after their symptoms have passed. (Hepatitis D, E, and G are all rare.)

All forms of viral hepatitis are contagious, but the routes of transmission vary. Hepatitis A is usually contracted from food or water contaminated by the fecal matter of an infected person. Anyone traveling to parts of the world where hygiene standards are low and hepatitis A infection rates are high is at risk for the disease.

Hepatitis B and C are spread primarily by the sharing of contaminated needles, blood transfusions, and sexual intercourse. High-risk groups for hepatitis B and C include people with multiple sexual partners, intravenous drug users who share needles, health-care workers, as well as people who had blood transfusions before 1970 when organizations screened for hepatitis C in the blood supply. Many people currently testing positive for hepatitis C, however, have no recollection of either an illness or a time when they might have acquired the infection, like a transfusion or an inadvertant needle stick.

Most acute hepatitis infections are mild and run their course in two to four weeks, although recovery can sometimes take as long as three months. Chronic hepatitis may linger for years, producing few or no symptoms, and may even subside spontaneously in some patients. In others, however, it sometimes can have very serious, possibly even life-threatening, consequences. Conventional antiviral drugs, such as interferon, have had only limited success in treating chronic hepatitis. Antioxidants and other supplements may help by protecting liver cells and boosting the immune system.

Fortunately, vaccines are now available for both hepatitis A and B, and they’re recommended for anyone in a high-risk group or for people who will be traveling to areas where hepatitis is common. Simple self-care measures, such as avoiding contaminated food and water, practicing safe sex, and washing your hands after using the toilet, can all reduce the risk of hepatitis and help prevent its spread.

Key Symptoms

Fatigue and general discomfort

Fever

Loss of appetite

Nausea and vomiting

Muscle or joint aches

Discomfort, pain, or swelling in the abdomen

Jaundice (a yellow tinge to the skin and whites of the eyes)

Dark urine and pale stoolsNote: Hepatitis C often has no discernable symptoms. If you are at high risk for hepatitis C infection you should be tested for the virus by your health care provider.

What Causes Hepatitis? Most cases are caused by a viral infection, passed either through contaminated food or water (hepatitis A) or through contaminated needles, blood transfusions, or sexual intercourse (hepatitis B and C). Sometimes a general viral infection, such as mononucleosis, will involve the liver and produce symptoms similar to viral hepatitis, but usually this is a short-lived problem with no long-term consequences. A noninfectious form of hepatitis may be caused by certain medications, exposure to toxic chemicals, and long-term alcohol abuse. In some rare cases, hepatitis is the result of an autoimmune disorder, in which the immune system attacks the body’s own tissues, in this case, the liver. And sometimes, the cause of hepatitis is unknown.

Conventional Treatments

Conventional Treatments for hepatitis depend on the particular infection you have, hepatitis A, B, or C, and the severity of infection. Generally the conventional treatments for hepatitis can be broken down into two categories: drug therapy or liver transplantation.

Hepatitis A: There are no prescribed drug regimens for infection with hepatitis A. The primary measure used to treat this form of hepatitis is to get enough nutrition via your diet, and to prevent any further damage to your liver. This may require eating smaller meals to combat nausea and or eating only early in the day. If you are diagnosed with hepatitis A you will also have to discuss all medication you are taking, both over the counter and prescription drugs, with your doctor. Your doctor can help you decide which medications will be the gentlest to your weakened liver. You should also avoid drinking alcohol while in the acute phase of your illness.

The first line of defense in combating hepatitis B infection calls for receiving an injection of immune globulin. This must be administered within 24 hours of infection, so contacting your physician is of utmost importance. After the 24 hour window has passed, conventional treatment for hepatitis B consists of two options: drug treatment or liver transplant. Note: Please see the following section for detailed information on drugs commonly prescribed for hepatitis B.

Live transplantation is only advocated in cases where the liver has been severely damaged by the virus. The current success rate for liver transplantation in the U.S. is approximately 90%. However, due to the scarcity of donor organs this is a procedure reserved for only the most severe cases of impairment.

All patients who present with hepatitis C are not given the same treatment regimen. In fact the National Institutes of Health only recommends conventional medical treatment if a) you test positive on an HCV ribonucleic (RNA) test, b) a biopsy shows you to have significant liver damage, and c) you possess elevated levels of a liver enzyme called alnine aminotransferase (ALT) in your blood. Given these conditions your doctor will want to discuss the implications of treatment for your stage of disease. Not all cases of hepatitis C require immediate treatment, or the harsh treatment regimens that conventional medicine has to offer. Note: Please see the following section for detailed information on drugs commonly prescribed for hepatitis C.

Depending upon the severity of your infection and the health of your liver, your doctor may elect to discuss the option of liver transplantation. Today transplantation technology is expanding to include the possibility of donating liver segments between family members, splitting donated livers between recipients, and the transplantation of HCV positive livers to other HCV positive recipients. All of these technologies seeks to make livers more readily available to the people with HCV who need them most. Discuss these new developments with your doctor, who can give you a more reasonable assessment of your qualifications for these programs.

Medications

There are no commonly prescribed medications for Hepatitis A infection.

Some commonly prescribed medications for Hepatitis B infection include:

Interferon supplementation may help strengthen your body’s immune response to the hepatitis virus. However, interferon has a number of serious side effects that include depression, anxiety, extreme fatigue, muscle pains, body aches, fever, and nausea. Interferon treatment generally consist of three injections per week for four to six months. With extended treatment you may be at risk for a more serious side effect: diminished ability to produce red blood cells. You should discuss all side effects and concerns with your physician before beginning any drug treatment.

Pegylated interferon is a form of interferon that shows greater efficacy because of its ability to stay in the body longer. This also reduces the burden on the patient, as shots of pegylated interferon are usually administered only once a week. Not everyone is a candidate for interferon treatment however. You should consult your physician about the suitability of these drug regimens for your specific condition.

Lamivudine/ Epivir is a antiviral drug in pill form. It helps prevent HBV from further infecting your cells by breaking the cellular chain of viral replication. Lamivudine/ Epivir pills must be taken once daily for at least one year. Common side effects include cough, diarrhea, nausea, vomiting, and hair loss. More rare but severe side effects include jaundice, increased susceptibility to bruising, bleeding, and fatigue. If any of these symptoms occur contact your doctor immediately.

Adefovir dipivoxil/ Hepsera is another antiviral drug that blocks viral replication. Adefovir dipivoxil/ Hepsera is a viable alternative to patients who do not respond to treatment with Lamivudine/ Epivir. The most common side effects of Adefovir dipivoxil/ Hepsera include weakness, headache, stomach pain, and nausea. If you have a history of kidney disease you are not a good candidate for treatment with Adefovir dipivoxil/ Hepsera, as it may exacerbate your condition.

The most common conventional treatments for hepatitis C are drug therapies. Patients are often prescribed interferon, pegylated interferon (PEG) or a combination of interferon and orally administered ribavirin. Standard treatment usually takes from 6 months to 1 year. Side effects from drug therapy can include: severe flu like symptoms, anemia, diminished capacity for your body to produce white blood cells and platelets, anxiety, irritability, and depression. In rare cases these side effects can balloon into episodes of psychosis and or suicidal behavior. Therefore, if you have a history of major depression, active thyroid disease, low blood cell counts, or autoimmune disease you should speak with your doctor before beginning any drug therapy for hepatitis C.

Test and Procedures

Hepatitis A can be diagnosed via a blood test. However, since antibodies can take weeks or even months to develop after infection, it is important not to be tested too early and receive a false-positive result. You should speak to your provider if you believe that you have been exposed to the hepatitis A virus.

Blood tests that screen for hepatitis B infection include:

Hepatitis B surface antigen (HBsAg) which tests the level of this antigen circulating in your bloodstream. High levels of HBsAg indicate that you are highly contagious and should be cautious before engaging in any activities that might put others at risk.

Antibody to hepatitis B surface antigen (anti-HBs) which looks for your body’s immune response to the hepatitis B virus. If you experience a positive result on this test, you have either a) recovered from a previous infection with HBV, or b) been inoculated against it. If this is the case, you are not in danger of infecting others. Your body’s natural immune response is poised to protect you from HBV.

Antibody to hepatitis B core antigen (anti-HBc) which used to diagnose chronic infection. This test is often administered as an adjunct to the previous two. If you test positive for hepatitis B core antibodies you may be infectious to others, or may be recovering from a previous bout of HBV. Your doctor will assess your individual case based on the results from the entire battery of tests assigned.

Hepatitis C can be diagnosed via a blood test and may also require a liver biopsy to assess the current health of your liver. If you require a liver biopsy, you can expect that your physician will administer you a local anesthetic before inserting a thin liver into your liver to retrieve the sample tissue. This tissue will then be sent to the lab for formal analysis.

Treatment and Prevention

The treatment for a case of acute hepatitis usually consists of resting, eating a proper diet (despite loss of appetite and nausea), and avoiding alcohol, which a damaged liver cannot metabolize effectively. A few liver-protecting supplements, such as antioxidants and milk thistle, can be taken during this period of rest and recuperation.

Chronic hepatitis is currently being treated with antiviral therapy, such as the drug interferon. Right now, there are antiviral and immune booster medications that are prescribed in cases of chronic hepatitis. However, there is no agreement in the medical profession as to when these drugs should be used, and their side effects make it difficult for some people to take them. A supplement program can be used both as an adjunct to taking anti-hepatitis medication, and to strengthen the body in cases where the drugs aren’t being used.

Hepatitis prevention is largely a matter of immunizing yourself against hepatitis A and B and avoiding possible sources of infection, such as contaminated foods and water, unsterilized needles, and infected sexual partners. If you are traveling to areas where hepatitis infection rates are high, get inoculated against both hepatitis A and B. The Food and Drug Administration (FDA) has approved three vaccines for hepatitis A. You should consult your physician as to which formulation is right for you. Remember to discuss your travel plans with your doctor well in advance of your travel, these vaccines take up to four weeks to take effect. The hepatitis B vaccine is administered in a series of three shots to patients of any age. Typically, children receive the vaccine at two, four, and nine months of age. There have been concerns over the past 10 years that there may be serious side effects to the hepatitis B vaccine in both adults and children. Research evidence has not found any link between administration of the hepatitis B vaccine and the incidence of multiple sclerosis (MS) in adults or the incidence of sudden infant death syndrome (SIDS) in babies. You should discuss all possible side effects of immunization with your doctor. The hepatitis B vaccine is strongly recommended for people in high-risk groups such as health-care workers and people with multiple sexual partners.

Along with any medication you take, it’s important to adopt and maintain a healthful diet that includes complete avoidance of any substance that might tax your liver. This means avoiding alcohol, certain drugs, tobacco, environmental toxins, and chemically-laced foods. Consider eating strictly organic foods to avoid toxic pesticides and herbicides. A good nutritional supplement program is a must, one that includes a variety of herbs and other compounds to help your liver and immune system keep the virus at bay.

Supplement Recommendations

It’s crucial to let your physician know which supplements you’re taking. He or she will be monitoring both your liver enzymes and virus level in your bloodstream.

Vitamin C and vitamin E are powerful antioxidants that protect liver cells against damage from unstable oxygen molecules called free radicals. Take them with alpha-lipoic acid, which provides additional antioxidant protection and may enhance the strength of vitamins C and E. Supplementation with these vitamins may also help combat any of the side effects of conventional hepatitis treatment (1, 2, 3). Ask your doctor for a list of foods that are high in vitamins C and E. Simply adding these foods to your diet can help improve your overall health as well as your condition.

Also take the herb milk thistle. Another powerful antioxidant and liver protector, milk thistle also promotes the regeneration of new liver cells and improves liver function. A systematic review of four trials also shows that milk thistle has a promising safety profile (4). Ask your physician if milk thistle may be a viable treatment option for you.

Licorice root has been shown to be a useful adjunct to conventional treatment for hepatitis (5, 6). The immunosuppressive and antiinflamatory properties of this supplement may aid in the treatment of hepatitis but, may not be a viable alternative for those with hypertension or other coexisting conditions. Check with your doctor before adding any new supplement to your diet.

Preliminary study results show that adding whey protein to your diet may also aid in the treatment of the hepatitis B virus (7). Ask your doctor for suggestions on how you can add more why protein to your diet.

Consider taking dandelion root in a liver-detoxifying product called a lipotropic combination, which also contains milk thistle and the B vitamins choline and inositol hexaniacinate. Lipotropic combinations are thought to help the liver rid itself of bile and toxins.

Chronic hepatitis will also benefit from SAMe, which sets up a chemical chain reaction that produces a powerful antioxidant and liver detoxifier. Phosphatidylcholine and supplements used in Ayurvedic medicine, phyllanthus, and a combination of Ayurvedic liver-support herbs, can also be taken to bolster the liver (8).

Some Chinese herbal prescriptions have been studied for their ability to eliminate the hepatitis virus, but they should be given under the care of someone who is trained in Chinese herbology (9, 10, 11, 12). A practitioner who is trained in Traditional Chinese Medicine may be able to help you identify a Chinese herbal regimen that can be a useful adjunct to conventional hepatitis treatment (13). You should consult your doctor and discuss any other supplement routines you begin with your doctor. Conventional studies of Chinese herbal preparations have shown mixed results as to the efficacy of certain herbal preparations (14). If you find that you cannot tolerate the side effects of conventional drug therapy for hepatitis Traditional Chinese Medicine may offer a viable alternative to severe side effects that often accompany conventional medications used to treat hepatitis (15).

Self-Care Remedies

Get plenty of rest. Mild cases of hepatitis may not require staying in bed, but naps and rest periods are usually needed.

Maintain good nutrition. The nausea, vomiting, and loss of appetite that hepatitis sometimes causes can result in skipped meals and poor nutrition. Because hepatitis symptoms tend to get worse as the day progresses, try to eat a hearty breakfast. Eating several small meals a day instead of a large lunch and dinner may help you deal better with nausea.

Don’t drink alcohol during the acute phase of an infection and for a month afterward, or until liver function tests show normal results. If you have chronic hepatitis, give up alcohol completely.

Try to assiduously avoid drugs that might tax your liver, including over the counter medications. Ask your doctor to review any medications you might be taking.

Try to avoid contaminated food and water when traveling. in areas where hepatitis is common. Drink only bottled water and avoid salads and other raw or undercooked foods.

Practice safe sex. Use condoms and try to avoid sexual contact with infected persons.

Make sure that any needles that puncture your skin, including tattooing, body piercing, and acupuncture needles, are either new or sterilized .

To avoid spreading hepatitis A, wash your hands with soap and water after using the toilet or changing diapers and before handling food.

Alternative Therapies

The most promising alternative therapies for hepatitis infection are the incorporation of supplements into your diet and or the addition of herbal preparations such as Traditional Chinese Medicine. The best evidence exists for supplementation with milk thistle, vitamin C, vitamin E, licorice root, alpha-lipoic acid, lipotropic combination therapy, and phosphatidylcholine. Less convincing but promising evidence exists for certain Chinese herbal preparations, Phyllanthus/Ayurvedic liver support combination, and SAMe.

When To Call a Doctor

If you suspect that you’ve been exposed to hepatitis by consuming contaminated food or drink, coming into contact with infected blood, or having sex with an infected person.

If you develop flulike symptoms that linger despite treatment.

If you develop jaundice or any other symptoms of viral hepatitis.

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