Vitamins that may be helpful
Catechin, a flavonoid, has helped people
with acute viral hepatitis,2 as well as individuals with chronic
hepatitis,3 though not all trials have found a benefit.4 A typical
amount used in successful trials is 500–750 mg three times per day. Although catechin is
found in several plants, none contain sufficient amounts to reach the level used in the
trials; thus, catechin supplements are needed. However, because of its potential to cause side
effects on rare occasions,5 catechin should be used only under medical
Proteins from the thymus gland, an important part of the immune system, may have a beneficial effect in people
with chronic hepatitis B. Initial trials done in Poland used injected thymus proteins with
good results.6 Further trials using a variety of thymus extracts by mouth have found that they can
improve blood tests that measure liver damage as well as improve immune cell
numbers.7 8 Preliminary evidence also suggests these extracts may help
patients with hepatitis C.9 The standard recommendation for supplementation is 200
mg three times per day of crude extracts or 40 mg three times per day of purified
SAMe (S-adenosylmethionine) (1,600 mg/day
orally or 800 mg/day intravenously) has been shown to aid in the resolution of blocked bile
flow (cholestasis), a common complication of chronic hepatitis.10 11
Taking 3 grams per day of
phosphatidylcholine (found in lecithin) was found to be beneficial in one investigation of
people with chronic hepatitis B.12 Signs of liver damage on biopsy were
significantly reduced in this trial.
Vitamin E levels have been shown to be low
in people with hepatitis,13 as well as in those who later develop liver cancer from
long-standing hepatitis.14 Vitamin E levels in the liver may also be decreased in
some people with hepatitis.15 In a controlled trial of individuals with hepatitis
B, 600 IU of vitamin E per day for nine months resulted in all signs of hepatitis disappearing
in five of twelve people.16 In a preliminary trial of adults with hepatitis C,
administering 1,200 IU per day of vitamin E for eight weeks appeared to reduce liver damage to
some extent.17 In a preliminary trial of people with hepatitis C, 544 IU of vitamin
E per day for 24 weeks improved the response to
interferon/antioxidant therapy, although
the results did not reach statistical significance.18 However, in children with
viral hepatitis, daily injections of vitamin E (300 IU) for seven days did not produce any
Vitamin C in the amount of 2 grams per day
was reported in a preliminary trial to prevent hepatitis infection in individuals receiving
blood transfusions.20 This report was followed up by a double-blind trial, in which
3.2 grams per day of vitamin C was reported to have no protective effect against
post-transfusion hepatitis.21 (However, in the latter trial, vitamin C actually
reduced the incidence of hepatitis by 29%, although this reduction was not statistically
significant.) An older trial suggested that injections of vitamin C may be helpful in treating
A potent antioxidant combination may protect the liver from damage in people with hepatitis
C, possibly decreasing the necessity for a liver transplant. In a preliminary
trial,23 three people with liver
cirrhosis and esophageal varices (dilated veins in the esophagus that can rupture and
cause fatal bleeding) caused by hepatitis C received a combination of Alpha lipoic acid (300 mg twice daily), silymarin
(from milk thistle; 300 mg three times daily),
and selenium (selenomethionine; 200 mcg twice
daily). After five to eight months of therapy that included other “supportive
supplements,” such as vitamin C and B
vitamins, all three people had significant improvements in their liver function and
overall health. Larger clinical trials are needed to confirm these promising preliminary
Vitamin B12 (with or without folic acid) has been reported in trials from the 1950s
to help some people with hepatitis.24 25 Vitamin B12 injections are
likely to be more beneficial than oral administration, though 1,000 mcg (taken orally) each
day can also be supplemented.
In a preliminary report, three patients with chronic hepatitis B had an improvement in the
severity of their hepatitis after taking 100 mg of thiamine (vitamin B1) per day.26
In a preliminary trial, supplementation with
betaine (20 grams per day) for 12 months improved signs of liver inflammation in seven
patients with nonalcoholic steatohepatitis, a type of liver inflammation. No significant side
effects were seen.27
Supplementation with 17 mg of zinc twice a
day (in the form of a zinc complex of L-carnosine) enhanced the response to interferon therapy in patients with chronic hepatitis
C, in a preliminary trial.28 It is not known whether this benefit was due primarily
to the zinc or the carnosine, or whether other
forms of zinc would have the same effect.
A preliminary trial found 24 grams per day of
whey protein improved blood measures of liver dysfunction in people with hepatitis B, but
not those with hepatitis C.29
Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.
Herbs that may be helpful
Preliminary trials have shown that the
bupleurum-containing formula sho-saiko-to can help reduce symptoms and blood liver enzyme
levels in children and adults with chronic active viral hepatitis.30 31
32 33 Most of theses trials were in people with hepatitis B infection,
though one preliminary trial has also shown a benefit in people with hepatitis C.34
Sho-saiko-to was also found, in a large preliminary trial to decrease the risk of people with
chronic viral hepatitis developing liver cancer. However, people who had a sign of recent
hepatitis B infection were not as strongly protected in this trial.35 The usual
amount of sho-saiko-to used is 2.5 grams three times daily. Sho-saiko-to should not be used
together with interferon drug therapy as it may increase risk of pneumonitis - a potentially
dangerous inflammation in the lungs.36
Cordyceps has repeatedly been shown
effective in clinical trials at reducing fibrosis and improving liver and immune function in
people with chronic hepatitis B, including those with cirrhosis.37 38
39 The usual amount taken is 3 to 4.5 grams twice daily as capsules or simmered for
10 to 15 minutes in water to make tea.
Silymarin, the flavonoid extracted from milk
thistle, has been studied for treating all types of liver disease. The standard amount
used in most trials has delivered 420 mg of silymarin per day. For acute hepatitis,
double-blind trials have shown mixed results.40 41 A preparation of
silymarin and phosphatidylcholine was reported
to help sufferers of chronic viral hepatitis. One small preliminary trial found that at least
420 mg of silymarin was necessary each day.42 A controlled trial found that
silymarin decreased liver damage.43 One trial has suggested that silymarin may be
more effective for hepatitis B as opposed to hepatitis C.44
Recent findings have shown that silymarin has the ability to block fibrosis, a process that
contributes to the eventual development of
cirrhosis in persons with inflammatory liver conditions secondary to alcohol abuse or
hepatitis.45 While there are no published clinical trials in people with hepatitis
C to date, this action makes milk thistle extract potentially attractive as a supportive
treatment for the condition—particularly for those that have not responded to standard
drug therapy. The effectiveness of silymarin (particularly its antifibrotic actions) needs to
be studied in larger numbers of persons with hepatitis C to determine whether it is an
effective treatment for this condition.
an Ayurvedic herb, has been studied primarily
in carriers of the hepatitis B virus, as opposed to those with chronic active hepatitis. In
one trial, administering this herb for 30 days appeared to eliminate the hepatitis B virus in
22 of 37 cases (59%).46 However, other trials have failed to confirm a beneficial
effect of Phyllanthus amarus against hepatitis B.47 48 A West
Indian species, Phyllanthus urinaria (not widely available in the United States or
Europe), has achieved much better results than Indian Phyllanthus
amarus.49 Thus, the specific plant species used may have a significant impact
on the results. The amount of phyllanthus used in clinical trials has ranged from
900–2,700 mg per day.
A crude extract of red peony root was shown
in a small, preliminary trial to reduce cirrhosis in some people with chronic viral
hepatitis.50 Other preliminary trials published in Chinese demonstrated that red
peony root was helpful (by reducing liver enzyme levels or symptoms or both) for people with
One of the active constituents in licorice,
glycyrrhizin, is sometimes used in Japan as an injected therapy for hepatitis B and
C.52 53 Glycyrrhizin also blocks hepatitis A virus from replicating in
test tubes.54 One preliminary trial found that use of 2.5 grams licorice three
times per day providing 750 mg glycyrrhizin was superior to the drug inosine polyIC in helping
people with acute and chronic viral hepatitis.55 Because glycyrrhizin can cause high blood pressure and other problems, it should
only be taken on the advice of a healthcare practitioner.
A series of cases of acute viral hepatitis were reported by one group in India, showing picrorhiza, combined with a variety of minerals,
to be helpful in hastening recovery.56 A variety of similar reports have appeared
in the Indian literature over the years, although no double-blind clinical trials have yet
been published. Between 400 and 1,500 mg of powdered, encapsulated picrorhiza per day has been
used in a variety of trials. Andrographis,
another traditional Indian herb, has shown preliminary benefit for people with chronic viral
Açaí root tea has reportedly been
used as a traditional remedy for hepatitis. Certain anthocyanins have been shown to prevent
liver toxicity, but açaí root contains no appreciable amounts of anthocyanins. No
clinical trials of any part of açaí for hepatitis have been published.
Preliminary human research demonstrates some efficacy for the mushroom reishi in treating chronic hepatitis B; however,
additional clinical trials are needed.58
An uncontrolled trial found that shiitake
formulations containing Lentinus edodes mycelium (LEM— the powdered mycelium of
the mushroom before the cap and stem grow) may help decrease blood markers of liver
inflammation.59 One marker of hepatitis B infection in the blood (HBeAg)
disappeared in 14% of the patients in this trial. Given the preliminary nature of the
research, more information is needed to determine if LEM is effective for hepatitis.
Modern Chinese research suggests that compounds called lignans in schisandra promote regeneration of liver tissue that
has been damaged by harmful influences, such as hepatitis viruses or alcohol. In a controlled
trial, Chinese patients with chronic viral hepatitis were given 500 mg schisandra extract
three times daily or liver extract and B vitamins.60 Among those given schisandra,
serum glutamic pyruvic transaminase (SGPT) levels declined to normal levels in 68% compared to
44% of the control group. Lower SGPT levels suggest less liver inflammation. There was also a
reduction in symptoms such as insomnia,
fatigue, loose stools, and abdominal tension
in the schisandra group. A preliminary trial in 5,000 people with various types of hepatitis
found normalizations in SGPT or related liver enzymes in 75% of cases using an unspecified
amount of schisandra.61
Early clinical trials in China suggest
astragalus root might benefit people with chronic viral hepatitis, though it may take one
to two months to see results.62 Textbooks on Chinese herbs recommend taking
9–15 grams of the crude herb per day in decoction form. A decoction is made by boiling
the root in water for a few minutes and then brewing the tea.
Another Chinese herb, Chinese scullcap,
might be useful for liver infections. However, the research on this is generally of low
Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.
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