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Health Protocols

Hepatitis C

Integrative Interventions

Because modern medicine has been so successful in treating hepatitis C, it is very important to seek professional medical attention for the disease and adhere to prescribed treatment regimens. You should not attempt to use natural interventions instead of seeking conventional medical care. The natural, integrative interventions discussed in this section may support liver and general health but are not replacements for highly effective modern DAA drugs.

Liver Glutathione and Oxidative Stress

Glutathione acts as a cellular detoxifier and helps prevent damage from free radicals.55 However, glutathione depletion is a common finding among HCV-infected patients.56 The following compounds may help increase glutathione levels.

N-acetyl-cysteine. N-acetyl-cysteine (NAC) is derived from L-cysteine, a conditionally essential amino acid. This powerful antioxidant diminishes free radicals and raises glutathione levels.57 Intravenous and oral NAC is used to treat acetaminophen poisoning in the hospital setting. In children with acute liver failure from causes other than acetaminophen poisoning, receiving NAC was associated with a shorter hospital stay, greater incidence of liver recovery, and better survival after transplantation.58 In an early trial, addition of NAC to interferon boosted glutathione levels in white blood cells of patients with chronic hepatitis C and normalized ALT levels in 41% of interferon non-responders.59 While more recent trials have been unable to confirm the therapeutic role of NAC in chronic hepatitis C, they have established that it is very well tolerated.60,61

S-adenosyl-L-methionine. S-adenosyl-L-methionine (SAMe), a methyl donor for numerous methylation reactions, has been studied for its antidepressant properties.62 SAMe also regulates glutathione synthesis.63 In HCV-infected patients who were non-responders to previous antiviral therapy, adding SAMe to a pegylated interferon plus ribavirin (PEG-IFN/RBV) regimen improved early viral response.64 In a separate trial, SAMe and trimethylglycine (another methyl donor) were given along with PEG-IFN/RBV to chronic hepatitis C patients. The treatment resulted in an early virologic response (EVR) in 59% of subjects, whereas PEG-IFN/RBV alone previously achieved only a 14% EVR.65

Lipoic acid. This free-radical scavenger helps repair damage caused by oxidative stress, assisting in the regeneration of important antioxidants such as glutathione and vitamin E.66 In animals, lipoic acid has been found to prevent fatty liver disease.67 In human trials, administration of antioxidant blends containing lipoic acid was shown to favorably modulate liver enzymes, HCV RNA levels, and liver biopsy score in HCV patients.68,69

Whey protein. Whey protein boosts glutathione levels and improves immune system function.70 In an animal model of hepatitis, whey protein supplementation attenuated chemical-induced liver enzyme elevations.71 Moreover, a clinical study found oral whey protein reduced viral load, decreased inflammation, lowered ALT levels, and exerted other beneficial effects in compensated chronic HCV-infected patients.70

Selenium. Selenium is an essential component of glutathione peroxidase, an enzyme that protects cells from free radical damage. Patients with hepatitis C or B have been found to have lower serum selenium concentrations than healthy individuals.72 Moreover, selenium deficiency is thought to contribute to insulin resistance in people with HCV-related chronic liver disease; and reduced selenium levels have been observed in patients with hepatocellular carcinoma.73,74

Glutathione. A 1989 study found consumption of oral glutathione increased plasma glutathione levels.75 Preclinical trials found oral glutathione increases glutathione levels in tissues such as the lungs, liver, and kidneys.76-80

Targeting Excess Iron Levels

Lactoferrin. Lactoferrin, an iron-binding glycoprotein, may be 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, it is directly involved in the upregulation of natural killer cell activity, making it a natural mediator of immune function.81 As an immune mediator, lactoferrin may work synergistically with interferon to reduce viral load.82 In a study of patients with chronic HCV, lactoferrin alone significantly lowered HCV RNA titer and improved efficacy of subsequent treatment with interferon and ribavirin.83

Green tea. Epigallocatechin-3-gallate (EGCG) from green tea has been found to interrupt the first step of HCV infection by blocking the virus from entering target cells. In addition, EGCG inhibited cell-to-cell transmission of HCV. Both effects were observed regardless of the genotype tested. These findings carry important implications for the prevention of HCV re-infection in liver transplant patients.84 In addition, green tea has been shown to inhibit iron absorption in intestinal cells85 and accumulation in liver tissue,86 which can contribute to excessive oxidative stress.

Elemental calcium. Calcium inhibits iron absorption.87 Taking 600 mg elemental calcium can reduce iron absorption by as much as 60%.88

Additional Natural Liver Support

Milk thistle. Silymarin and its chief active ingredient, silibinin, are derived from milk thistle, a member of the daisy family. Both substances help the liver avoid toxic damage and regenerate after injury.

Silymarin

Findings from several studies suggest silymarin has potential antiviral,89 antioxidant,90 anti-inflammatory,89,91 and antifibrotic92 effects within the liver. It may also improve liver enzyme levels in HCV patients.93

In a recent cell culture study, silymarin inhibited HCV entry into cells, inhibited viral RNA and protein expression, and decreased cell-to-cell transmission of HCV.94

A clinical study involving 1,145 HCV-infected participants showed patients using silymarin had fewer liver-related symptoms and somewhat higher quality-of-life scores.95 Doses greater than 700 mg may improve bioavailability of silymarin; and oral doses up to 2.1 grams per day have been found to be safe and well tolerated.96

Silibinin

The antioxidant, antifibrotic, and metabolic effects of silibinin have been demonstrated in numerous studies.97,98 Silibinin also has antiviral capabilities.99,100

The clinical efficacy of oral silibinin in active chronic hepatitis C has not yet been clearly established.97,101 However, intravenous silibinin effectively treated HCV re-infection following liver transplantation in a small number of patients in one trial,102 and helped 85% of non-responders to standard of care achieve undetectable HCV RNA levels in another.103 Likewise, administering high doses of intravenous silibinin in addition to PEG-IFN/RBV therapy lowered viral loads in HCV-infected patients who were previous non-responders to treatment100; and 1,400 mg intravenous silibinin daily for 14 days successfully induced SVR in a 57-year-old liver transplant patient.104

A medical literature review found no significant side effects with silybin phytosome at doses up to 10 grams per day, and no significant interactions with other medications.97

Polyenylphosphatidylcholine. Polyenylphosphatidylcholine (PPC) is a major component of essential phospholipids.105 In addition to improving liver enzymes in HCV, 106 PPC replenishes levels of SAMe, a precursor to the potent antioxidant glutathione.107 PPC protects against liver damage105 and improves liver function.106,108 In animal studies, it has demonstrated antioxidant, cytoprotective, anti-inflammatory, and antifibrotic effects, inhibiting oxidative stress and the development of alcoholic liver disease.105,106 Numerous double-blind placebo-controlled clinical trials have shown essential phospholipids improve chronic hepatitis among human subjects.109

Schisandra chinensis. Berries from the Schisandra chinensis plant contain active ingredients that protect the liver. Crude schisandra and its extracts have traditionally held a role in Chinese and Japanese medicine,110 and S. chinensis has been used to treat chemical and viral hepatitis.111 A study examining the effects of a Japanese herbal combination containing S. chinensis indicated Schisandra fruit could inhibit HCV infection.112 The seed extract from S. chinensis appears to have liver-detoxifying capabilities, and components of the seed extract are thought to have anticancer, anti-inflammatory, liver-protective, anti-HIV, and immunomodulating effects.113

Licorice root extract. Licorice root extract (glycyrrhizin) is known to exert an antiviral effect against HCV.114 In Japanese HCV patients, long-term use of glycyrrhizin was shown to be helpful in preventing inflammation, liver cirrhosis, and hepatocellular carcinoma.115,116 The broad anti-inflammatory activity117 and antioxidant capabilities 118 of glycyrrhizin have also been observed. Adding a nutritional supplement containing vitamin C, glycyrrhizic acid, and other antioxidants to standard PEG-IFN/RBV treatment has been linked to a notably higher rate of biochemical and histologic improvements in patients with chronic HCV.119,120 In chronic HCV patients, oxidative stress and immunological parameters showed marked improvement following treatment with this blend.119

A preparation known as Stronger Neo-Minophagen C (SNMC) contains glycyrrhizin as an active component and has been used in Japan for more than 30 years to treat chronic hepatitis.116 In animals with HCV, SNMC has been found to prevent fatty liver disease121 and protect liver cells against carbon tetrachloride-induced oxidative stress by restoring depleted glutathione levels.122 A possible side effect associated with ingestion of large amounts of licorice is hypertension123; therefore, blood pressure should be monitored regularly.

Vitamin D. Diminished vitamin D levels have been observed in HCV patients.124,125 Low serum vitamin D levels are associated with severe fibrosis, as well as a low SVR to PEG-IFN/RBV treatment in patients with chronic HCV infection125; and vitamin D supplementation has been found to enhance HCV response to PEG-IFN/RBV therapy.126 In a recent study involving patients with HCV genotype 2-3 receiving PEG-IFN/RBV treatment, supplementing with oral vitamin D significantly improved viral response. Twenty-four weeks after treatment, 95% of the treatment (vitamin D) group was HCV RNA negative versus 77% of the control group.127

Coffee. A recent study showed patients with advanced HCV-related chronic liver disease who drank 3 or more cups of coffee per day were about 3 times more likely to respond to PEG-IFN/RBV treatment than non-drinkers. These patients were previous non-responders to interferon treatment.128 Published study reports have documented an association between coffee consumption and lower risk of liver cirrhosis,129,130 hepatocellular carcinoma,131,132 liver disease progression in HCV infection,133 and lower serum ALT activity.134 Population studies have shown coffee drinking reduces the risk of clinically significant chronic liver disease.135 These effects may be due in part to the antiviral activity of chlorogenic acid, a coffee polyphenol found in especially high concentrations in green coffee extracts.136

Zinc and zinc-carnosine. Zinc has HCV-inhibiting capabilities.137 Zinc supplementation has resulted in a higher reported rate of HCV eradication among patients receiving interferon treatment,138 decreased gastrointestinal disturbances and hair loss, and improved fingernail health in patients with chronic HCV. It may also improve patient tolerance to IFN-alpha-2a and ribavirin.139

A chelate compound consisting of zinc and L-carnosine may induce antioxidative functions in the liver, thereby decreasing liver cell injury.140 Supplementation with chelated zinc-carnosine has been found to lessen the degree of liver damage and improve long-term outcome of patients with chronic HCV infection or liver cirrhosis.141 In patients with HCV-related chronic liver disease, it appears to have an anti-inflammatory effect on the liver by decreasing iron overload.142 In addition, fewer gastrointestinal side effects were observed when zinc-carnosine was added to combination PEG-IFN/RBV therapy.143

Curcumin. Curcumin is a yellow pigment present in the curry spice turmeric. It possesses antioxidant, anti-inflammatory, anti-fungal, antibacterial, and anti-proliferative capabilities.144-146 In addition, curcumin has been found to exert antiviral activity against a variety of viruses including HIV,147 influenza virus,148 and coxsackievirus.149 One team of researchers found that curcumin reduces HCV gene expression, and combining curcumin with IFN-alfa treatment had "profound inhibitory effects" on HCV replication. The authors concluded curcumin may be valuable as a novel anti-HCV agent.150 Curcumin has also been shown to protect against liver cancer.151

Quercetin. Quercetin, a flavonoid present in fruit, vegetables, wine, and tea, has antioxidant and anti-inflammatory properties. Studies indicate it also possesses anti-hypertensive, antibacterial, anti-fibrotic, anti-atherogenic, and anti-proliferative properties.152 Quercetin has also been found to attenuate HCV virus production.153,154

L-carnitine. Chronic HCV patients received PEG-IFN/RBV plus the amino acid L-carnitine or PEG-IFN/RBV alone for 12 months. A significant improvement in sustained virologic response was observed in 50% of the L-carnitine group versus 25% of the non-L-carnitine group.155 Supplementing PEG-IFN/RBV treatment with L-carnitine has also been associated with decreased mental and physical fatigue, as well as improved health-related quality of life in patients with chronic HCV. These latter outcomes could potentially improve patient compliance with PEG-IFN/RBV treatment.156


Disclaimer and Safety Information

This information (and any accompanying material) is not intended to replace the attention or advice of a physician or other qualified health care professional. Anyone who wishes to embark on any dietary, drug, exercise, or other lifestyle change intended to prevent or treat a specific disease or condition should first consult with and seek clearance from a physician or other qualified health care professional. Pregnant women in particular should seek the advice of a physician before using any protocol listed on this website. The protocols described on this website are for adults only, unless otherwise specified. Product labels may contain important safety information and the most recent product information provided by the product manufacturers should be carefully reviewed prior to use to verify the dose, administration, and contraindications. National, state, and local laws may vary regarding the use and application of many of the treatments discussed. The reader assumes the risk of any injuries. The authors and publishers, their affiliates and assigns are not liable for any injury and/or damage to persons arising from this protocol and expressly disclaim responsibility for any adverse effects resulting from the use of the information contained herein.

The protocols raise many issues that are subject to change as new data emerge. None of our suggested protocol regimens can guarantee health benefits. The publisher has not performed independent verification of the data contained herein, and expressly disclaim responsibility for any error in literature.

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