Hepatitis B Virus (HBV) Overview


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9.3 Complementary Medicine

9.3 Complementary Medicine

To my knowledge there is no proven cure for hepatitis B in this area of medicine, this is not to say there is no cure in these areas. The problem is there is very little research being done and controlled studies are uncommon. Where a person has been "cured" due to the lack of double blind studies with reasonable to large groups of people it is difficult to say if it would have happened anyway as occurs in between 2%-5% of people each year or due to the complementary medicine.

However there are treatments available where it is believed that damage due to hepatitis may be limited, cause relief of symptoms, help with interferon side effects etc

A note of caution, some herbs and minerals given to people can have been found to cause liver damage and some herbs increase liver enzymes and so mask the results of conventional treatment/ongoing disease. Some in only in a small percentage of people, some in all and some may be dosage dependent, I therefore advise you to research any herbs and minerals you decide to take and discuss them with your medical practitioner and make an informed decision.

This is a large topic and information is taken from various sources. Unfortunately the scientific rigour of controlled studies, double blind trials and confirmation of results rarely occurs with complementary therapy and some times outrageous claims are made. Similarly often useful treatments are ignored by conventional medicine. So please treat the information here as a pointer to your own research. Also the length of the information does not signify the value of it!

I hope to expand this section further in future versions however various herbs, vitamins, amino acids etc you may wish to research are:- Milk Thistle (Silymarin); Aloe Vera; Thymic Factors, Mega doses of Vitamin C; Melatonin; Methinonine (An amino acid), Acytyl-L-Cystine, Choline, Ginseng (Note: This may have a mild imunosupressive effect through glycocortisoid action and is therefore not advised if taking interferon, although a course before starting on interferon may have a slight priming effect for the immune system and be beneficial(?) ); Goldenseal; licorice root; Gotu Kola; details of some of these are shown below:-

Artichoke (CYNARA SCOLYMUS, Cynarin, CAFFEIC ACID )

  • An excerpt from the following article: SILYMARIN COMPLEX FOR LIVER DISORDERS by Michael T. Murray, N.D. published in "Health World" spring 1987.

    The artichoke has a long folk history in treating many liver diseases. Recent evidence supports this long-time use. The active ingredient in artichoke is cynarin. this compound is found in highest concentrations in the leaves.

    Like silymarin, cynara extract has also demonstrated significant liver-protecting and regenerating effects. it also possesses choloeretic effect, promoting the outflow of bile from the liver to the gall-bladder. This is a very important property. If the bile is not being transported adequately to the gallbladder, the liver has an increased risk of being damaged. Choleretics are very useful in the treatment of hepatitis and other liver diseases via this "decongesting" effect.

    Choleretics typically lower cholesterol levels via their ability to decrease the synthesis of cholesterol in the liver. Consistent with its choleretic effect, cynara extract has been shown to lower blood cholesterol and triglyceride levels in both human and animal studies.

  • CLINICAL TRIALS OF CYNARA SCOLYMUS
    In a controlled trial, two groups of 30 patients having elevated serum cholesterol and triglycerides were given either cynarin (500 mg. per day) or a placebo. Cynarin proved to induce a significant reduction of these elevated cholesterol and triglyceride levels.

    In addition, the patients also displayed a reduction in body weight. This effect was probably a result of cynarin's diuretic activity.

  • CAFFEIC ACID
    It appears cynarin, the active component in artichoke leaves extracts, is not the true active substance. Since cynarin can be broken down into caffeic acid in the gastrointestinal tract, it is conceivable that the true active component is caffeic acid. This compound has demonstrated a significant liver-protecting effect as well as choloeretic activity.

    Cynara Extract has also demonstrated significant liver-protecting and regenerating effects.

    Liquorice root

  • From the "Encyclopaedia of Natural Medicine", Michael Murray, N.D. and Joseph Pizzorno, N.D.

    The recommended dosage of Liquorice (Glycyrrhiza glabra) for hepatitis of all kinds is:  

    (Doses 3 times per day)

    Dried root (or as tea, 1 to 2 g.

    Tincture (1:5), 4-6ml (1 to 1.5 tsp)

    Fluid extract (1:1), 0.5-2.0 ml (1/4 to 1/2 tsp)

    Powdered solid extract (4:1), 250-500 mg

    If liquorice is used over a long time it is necessary to increase the intake of potassium rich foods.

    Double-blind studies have shown a liquorice component to be effective in treating viral hepatitis, particularly chronic active hepatitis. This activity is probably due to its well documented antiviral activity. A glycyrrhizin-containing product (Stronger Neo-minophagen C), consisting of 0.2 per cent glycyrrhizin, 0.1 per cent cysteine and 2.0 per cent glycine in physiological saline solution, is widely used intravenously in Japan for the treatment of hepatitis. The other components, glycine and cysteine, appear to modulate glycyrrhizin's actions. Glycine has been shown to prevent the sodium- and water-retaining effects of glycyrrhizin, while cysteine aids in detoxification via increased glutathione synthesis and cystine conjugation.

  • Licorice as a liver herb by Paul Bergner  
    Licorice root (Glycyrrhiza glabra) is a time-honoured herbal medicine in all world herbal traditions. It is used as a primary herb in perhaps more categories than any other medicinal plant. It is used with success for acute respiratory problems, gastric ulcers, gastritis, inflammatory conditions in general, and adrenal exhaustion. Components of licorice root have both estrogenic and anti-estrogenic activity (Leung; Kraus; Kumagai et al; Sharaf and Goma; Tamaya et al). It is thus an important herb for treating hormone-related female problems. It has not traditionally been used as a liver herb, but medical research over the past two decades in Japan and China has shown that licorice is also an important liver herb with strong hepatoprotectant properties. This should not be thought of as just another minor use for licorice. It is as significant a hepatoprotectant as the better-known milk thistle seed, and acts through separate mechanisms than that herb.

    The two together should be considered in any hepatoprotecant formula or treatment plan. Form and dose Most of the Asian clinical research and practice has been with glycyrrhizin, a major constituent of licorice root. The product in most Japanese trials is Strong Neominophagen-C (SNMC) which contains 40 mg glyzyhhrizin, 20 mg cysteine, and 400 mg glycine in 20 ml saline solution. Cysteine and glycine are amino acids. A typical treatment for hepatitis is 40 ml of SNMC a day for thirty days delivering 80 mg of glycyrrhizin per day (Hikino). The upper range of clinical trials has been 200 ml SNMC (400 mg glycyrrhizin) (Mori et al, 1989, 1990), but trials above 100 ml (200 mg glycyrrhizin) have been rare, due to concern over possible side effects (see below) (Hikino). Oral extracts Comparable therapeutic levels of glycyrrhizin can probably be reached with oral preparation; important active constituent of licorice, and therapeutic levels for a wide variety of conditions are easily achieved with oral administration. Licorice root (G. glabra) contains 6-14% glycyrrhizin ( erck), so an oral dose of 7-8 grams powdered licorice would deliver it.

  • HEPATITIS
    Clinical trials for hepatitis, especially chronic active hepatitis, have been so successful in Japan that glycyrrhizin is now a standard medical treatment there (Kumada et al; Matsunami et al.; Ohta et al; Su et al; Suzuki et al; Wang; Zhang et al).

  • MECHANISMS OF HEPATOPROTECTION
    The mechanisms of hepatoprotection are diverse, and include antioxidant activity (Kiso et al; Abdugafurova et al; Tan; Ju et al), direct antiviral effects (Hikino; Crance), enhancement of interferon production (Hikino; Shinada); enhanced antibody production (Hikino), enhancement of extrathymic T-Cell activity in the liver (Kimura et al), and protection from immunological (auto-immune) injuries (Hikino; Mizoguchi et al). A number of animal and in vitro trials have shown that glycyrrhizin can protect liver cells from damage from a variety of chemical or immunological agents (Nakamura et al; Mizoguchi et al; Shibayama; Shiki et al; Zhao et al).

  • OTHER CLINICAL TRIALS
    Glycyrrhiza has also been effective in treating HIV/ARC in haemophiliacs, and, notably, improved liver dysfunction in these patients (Mori et al, 1990; Mori et al, 1989). It has also been effective in preventing the hepatic side effects of chemotherapy with a methotrexate combination or interferon (Akimoto et al; Hayashi et al), and in treating general hepatic failure (Acharya).

  • ENTEROHEPATIC CYCLING
    One reason licorice is so effective in treatment of the liver is that it enters the enterohepatic loop, that is, it is excreted in the bile, then reabsorbed in the gut to recycle repeatedly through the liver (Ichikawa; Ishida).

  • SIDE EFFECTS AND DRUG INTERACTIONS
    Licorice produces well-documented side effects when taken in large doses (>>50 g/day) or for long duration (>>six weeks) (Wichtl). No such side effects have been observed in clinical trials of 40 ml SNMC/day for thirty days, or with 100 ml SNMC (200 mg glycyrrhizin/day) ~for a short period~ (Hikino). With widespread use of SNMC in japan, hyperaldosteronism was seen with larger doses and extended use (SNMC). The side effect is reversible on discontinuation of glycyrrhizin. Licorice or glycyrrhizin may also interact with herbs or other medications containing cardiac glycosides.

    Milk Thistle (Silymarin, blessed thistle, Chardon Marie)

    Milk Thistle (Silymarin) is reported to be an anti-inflammatory and mast cell stabilizer that helps protect the liver against toxin, drugs, and the affects of alcohol (Better Nutrition for Today's Living, March 1993).I . Two capsules of 100mg extract of milk thistle (Silybum marianum) containg 70% sillymarin (ie 140mg of silymarin) are normally taken so twice or three times a day. European research shows that it stimulates regeneration of liver cells and protects them from toxic injury" It is usually stocked in health food stores under the names milk thistle, silybum, or silymarin.

    In germany milk thistle is frequently prescribed to those on interferon.

    From the Encyclopedia of Natural Medicine Michael Murray, N.D. and Joseph Pizzorno, N.D.

    The common milk thistle contains some of the most potent liver protective substances known, a mixture of three flavanolignins colelctively referred to as silymarin. (30-33) The concentration of silymarin is highest in the fruit, but it is also found in the seeds and leaves.

    Silymarin's effect in preventing liver destruction and enhancing liver function relates largely to its ability to inhibit the factors that are responsible for hepatic damage, i.e., free radicals and leukotrienes, coupled with an ability to stimulate liver protein synthesis. (30-33)  

    Silymarin prevents free radical damage by acting as an antioxidant.

    Silymarin is many times more potent in antioxidant activity than vitamin E. Silymarin not only prevents the depletion of glutathione (GSH) induced by alcohol and other liver toxins, but it was shown to increase the basal GSH of the liver by 35 per cent over controls in one study. This is extremely useful when exposure to toxic substances is high, due to glutathione's vital role in detoxification reactions.

    The protective effect of silymarin against liver damage has been demonstrated in a number of experimental and clinical studies. (30-38) Experimental liver damage in animals can be produced by such diverse toxic chemicals as carbon tetrachloride, amanita toxin, galactosamine and praseodymium nitrate. Silymarin has been shown to protect against liver damage by all of these agents. (30-33)

    Another way in which the liver can be damaged is by the action of leukotrienes. These compounds are produced by the transfer of oxygen to a polyunsaturated fatty acid. This reaction is catalysed by the enzume lipoxygenase. Silybum components inhibit this enzyme, thereby inhibiting the formation of these damaging compounds.

    Perhaps the most interesting effect of silybum components on the liver is their ability to stimulate protein synthesis. (30-33) The result is an increase in the production of new liver cells to replace the damaged old ones. This demonstrates that silymarin exerts both a protective and restorative effect on the liver.

    In human studies, silymarin has been shown to have positive effects in treating liver diseases of various kinds, including cirrhosis, chronic hepatitis, fatty infiltration of the liver (chemical and alcohol induced fatty liver) and inflammation of the bile duct. (32-38) The therapeutic effect of silymarin in all of these disorders has been confirmed by histological (biopsy), clinical and laboratory data. Silymarin is especially effective in the treatment and prevention of toxic chemical or alcohol induced liver damage. (32-38)

    REFERENCES:

    30. Hikino, H. Kiso, Y., Wagner, H. and Fiegig, M., "Antihepatotoxic actions of flavonolignans from Silybum marianum fruits", Planta Medica, 1984, 50, pp 248-50

    31. Vogel, G., Trost, W., Braatz, R., et al., "Studies on pharmacodynamics, site and mechanism of action of silymarin the antihpatotoxic principle from Silybum marianum (L.) Gaert"., Arzneim-Forsch, 1975, 25, pp 179-85 

    32. Wagner, H., Antihepatotoxic flavonoids", in Cody, V., Middleton, E. and Harbourne, J.D. (eds), Plant flavinoids in Biology and Medicine: Biochemical, Pharmacological and Structure-Activity relationships, Alan R. Liss, New York, NY 1986, pp545-58

    33. Wagner, H., "Plant constituents with antihepatotoxic activity", in Beal, J.L. and Reinhard, E. (eds) Natural Products as Medicinal Agents, Hippokrates-Verlang, Stuttgart, 1981

    34. Sarre, H., "Experience in the treatment of chronic hepatopathies with silymarin", Arzneim-Forsch, 1971, 21, pp 1,209-12

    35. Canini, F., Bartolucci, A., Cristallini, E., et al., "Use of silymarin in the treatment of alcoholic hepatic stenosis", Clin. Ther., 1985, 114, pp 307-14

    36. Salmi, H.A., and Sarna, S., "Effect of silymarin on chemical, functional, and morphological alteration of the liver. A double-blind controlled study" Scand.J.Gastroenterol., 1982, 17, pp 417-21

    37. Scheiber, V., and Wohlzogen, F.X., "Analysis of a certain type of 2 x 3 tables, exemplified by biopsy findings in a controlled clinical trial", Int.J.Clin.Pharmacol., 1978, 16, pp 533-5

    38. Boari, C., Montanari, M., Galleti, G.P., et al., "Occupational toxic liver diseases. Therapeutic effects of silymarin", Min.Med., 1985, 72, pp 2,679-88.

     

    Some Modern Uses of Milk Thistle Seed by Paul Bergner

    Milk thistle seed extracts, usually standardized to 70% silymarin content, are commonly used in conventional medicine in Europe, where it has been officially available since 1969. More than $180 million in silymarin products were sold in Germany alone in one recent year. The trials below all used this 70%-silymarin pharmacetuical preparation, but this does not in any way prove that only such preparations would have this clinical result. See the accompanying articles for reports of clinical use of other forms of milk thistle seed.

    HEPATITUS

    In 77 patients with acute viral hepatitis, 42 were treated with placebo and 35 with a milk thistle seed extract. Recovery time for the placebo group averaged 43 days, and for the silymarin group, 29 days (Legalon).

    ALCOHOLIC CIRRHOSIS

    In a well-controlled double-blind study of ninety-six cases of alcholic hepatic cirrhosis, forty-nine patients were treated with placebo and forty-seven with silymarin. After a five-year period, there were only five deaths (10.5%) in the silymarin group, and fourteen deaths (28.5%) in the control group (Benda et al).

    PEDIATRIC LIVER DISEASE

    In a study of 166 children under the age of seventeen with chronic liver disease, the following results were obtained: For cases of chronic persistent hepatitis, 70% showed improvement, 27% stabilized; 4% had no improvement or stabilization. For cases of chronic active hepatitis, 32% showed improvement; 44% stabilized, and 24% had no beneficial effect (Jodl et al).

    FATTY DEGENERATION

    In a group of 88 patients with toxic-metabolic liver damage due to alcohol abuse or diabetes mellitus, elevated transmaminase values and abnormal bromsulphalein test results tended to revert to normal. Ninety-one abnormal test results fell to only 37 (59% improvement) after treatment with silymarin (Fintelman V).

    PHARMACEUTICAL DRUGS

    In a study of sixty-six female patients taking spychopharmacological or anticonvulsant agents for neurological or psychiatric problems, liver function tests gave a total of 71 abnormal results. Fifty-two of these (73% responded to silymarin treatment, the gret majority of them returning to normal ranges (Legalon).

    ANESTHESIA

    In sixty-one patients receiving anesthesia using halothane or hexobaribtal, the thrity-two control showed a distinct post-operative rise in serum enzymes. Twenty-nine patients receiving silymarin showed no such rise (Benda and Zenz).

    OCCUPATIONAL TOXINS

    Studies showed that silymarin could rapidly cure workers producing pesticides who had disturbed liver function; other studies showed that in forty patients with posioning by silicon dioxide, the effect could be completely antagonized by silymarin at certain doses (Legalon)

     

    Phylanthus Amarus/Nituri/Nirruri (the Ayurvedic name is Bhumy Amalaki)

     Effect of Phyllanthus amarus on chronic carriers of hepatitis B virus. Lancet. 2(8614):764-6, 1988 Oct 1.

    "Abstract: In a preliminary study, carriers of hepatitis B virus were treated with a preparation of the plant Phyllanthus amarus for 30 days. 22 of 37 (59%) treated patients had lost hepatitis B surface antigen when tested 15-20 days after the end of the treatment compared with only 1 of 23 (4%) placebo-treated controls.

    Some subjects have been followed for up to 9 months. In no case has the surface antigen returned. Clinical observation revealed few or no toxic effects. The encouraging results of this preliminary study recommend continued evaluation of this plant and the active principles isolated from it."

    Please note the small numbers of patients and the emphasis that this is a preliminary study. A medline search shows that many researchers have failed to confirm these findings, while others show prominsing, usually in vitro, results.

     

    Thymus Extracts

    Excerpts from Dr. Julian Whitaker's "Health and Healing" monthly newsletter. Oct. 1992, Vol. 2. No. 11. The "proofs" offered re: oral thymus supplements are mostly anecdotal.  

    The thymus gland controls your immune system in to basic ways. First it is the source of T-lymphocytes or T-cells (T stands for thymus), which are crucial in the fight against viruses, bacteria, yeast, and all other foreign invaders. Early in life the thymus gland seeds the bone marrow with immature T-cells, where they multiply and mature. It is the T-cells that are destroyed by the HIV virus and their destruction brings on full-blown AIDS.

    Second, the thymus gland produces a variety of hormones that stimulate the maturation of T-cells and increase the production of other immune hormones, such as interferon and the immune globulins. Several hormones from the thymus gland have been isolated, but the one receiving the most attention right now is thymosin alpha 1.

    Researchers all over the world are exploring the therapeutic possibilities of thymus hormone replacement, but none are more vigorously than Milton Mutchnick, MD, head of the department of gastroenterology at Hutzel Hospital and associate professor of medicine at Wayne State University medical Center in Detroit. He recently published a year-long study demonstrating that a synthetic injectable version of a thymus hormone, thymosin alpha 1, given twice weekly, eliminated the hepatitis B virus in six out of seven pations (86%), compared to a spontaneous conversion of one out of five (20%) in the placebo group.

     

    EUROPEAN STUDIES SHOW VALUE OF THYMUS EXTRACT

    Oral products of thymus extract are shunned in this country because most researchers believe that the digestive juices in the stomach and intestines will destroy them before they are absorbed. However, in Europe, an oral thymus product, Thymodulin, with sales of over $300 million a year, has been sued and studied for almost a decade. Control trials show that it significantly improves a variety of conditions and even eliminated hepatitis b in 45% to 50% of children, compared to only 20% in the control group.

    In one convincing study, oral Thymodulin was administerd to 29 patients: eight with herpes zoster, eight with whooping cough, eight with chicken pox and five with infectious mononucleosis.

    Another 29 patients with the same diseases received a placebo.

    Various parameters were used to measure the effectiveness of Thymodulin, and all patients who received it showed significant improvement compared to controls.

    Dr. Burgstiner (Savannah GA) contracted Dr. Mutchnick, who was very interested in Dr. Burgstiner's experience and wanted to have a look at the product he had used. Dr. Mutchnick took Immunoplex 402 and the vitamin preparation himself, and then measured his blood levels of thymosin alpha 1. He wrote Dr. Burgstiner: "You might be pleased to know that I conductd a pilot study on myself by taking several of the Immunoplex 402 tablets after having first obtained a pretreatment serum, which was followed then by serums at 1/2 hour, 1 hour, 2 hours, 3 hours, and 4 hours. Lo an behold, by the first hour--and consistently for the next several hours--the thymosin alpha 1 level, as determined by the ELISA, increased. Clearly, I will have to repeat this on a number of subjects, but this offers an exciting potential for turning thymosin alpha 1 from a subcutaneous injection into an oral preparation."

    Dr. Burgstiner encouraged Melvin L. Haysman, MD, who practices allergy and clinial immunology in Savannah, to try the products with some of his patients. Dr. Haysman collected before and after blood smaples of about a dozen patients who took Immunoplex 402 with the vitamins and minerals, and sent them to Dr. Mutchnick.

    Dr. Mutchnick found that the products had increased the blood levels of thymosin alpha 1 in every patient, and in some by 300% to 700%.

     

    WHY NUTRITIONAL SUPPLEMENTS SHOULD BE ADDED

    Vitamin and mineral supplements taken with the Immunoplex 402 markedly enhance the effect of the product. Dr. Mutchnick found that three Immunoplex 402 tablets taken with one vitamin and mineral supplement elevated the blood level by over 300%, and three Immunoplex 402 tablets plus two of teh vitamin and mineral supplements caused an almost 450% rise in thymosin alpha 1 hormone.

    It should not be a surprise that supplemental nutrients would have this effect on the oral preparation. In one recent study from italy, zinc sulfate was added to the serum of patients with Down's syndrome (known to have very low levels of thymus activity) and of elderly patients, also with characteristically low levels of active thymus hormone. The active hormone in their serum icnreased to that of young, healthy individuals.

    The authors theorized that zinc is necessary to activate thymus hormone, and that marginal zinc deficiences could be a cause of immune dysfunction and decreased function of thymus hormone even when it was present. The same is likely true for other essential nutrients as well. One of the first and most consistent signs of any nutrient dificiency is immune dysfunction. But very few doctors prescribe nutritional supplements. They all "know" they don't work. And blah blah blah....

     

    THE POTENTIAL FOR PREVENTING AGE-RELATED DISORDERS

    The ability to maintain high levels of thymus hormone activity has enourmous petential for alleviating suffering from age-related diseases, and the anecdotal experience of Drs. Burgstiner and Haysman is remarkable. Dr. Burgstiner has been keeping a running tally of th benefits reported to him by patients and doctors of patients who have tried the preparations. This is not a scientific study, but over the last two years...

    63 patients have reported complete recovery from Hep B.

    3 patients with Hep C recoverd

    26 patients with chronic fatigue syndrome reported marked improvement.

    24 patients with rheumatoid arthritis -- some taking methotrexate, cortisone, and gold shots, indicating very severe conditions -- reported almost complete remission of symptoms and elimination of strong medications.

     

    Tumeric (Curcumin)

    An excerpt from the following article: SILYMARIN COMPLEX FOR LIVER DISORDERS by Michael T. Murray, N.D. published in "Health World" spring 1987

    Curcumin is the yellow pigment of tumeric. Curcumin shares some of the same effects on the liver as silymarin and cynarin. It has demonstrated similar liver protection activity to silymarin. Curcumin is believed to also be converted to a choleretic compound, perhaps even caffeic acid. Curcumin's documented choleretic effects support its historical use in treating liver and gallbladder disorders. Like cynara extracts, curcumin has also been shown to lower cholesterol levels.

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    GLOSSARY

    Next chapters are :

    10. Other Hepatitis B Information
    10.1 Coinfections with other viruses
    10.2 Non "e" Antigen Hepatitis
    10.3 Relapse
    10.4 Liver Cancer (hepatocellular carcinoma, hepatoma or HCC)
    10.5 Living with the Hepatitis B Virus
    10.6 Cirrhosis of the Liver
    Appendixes
     

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