7 Complementary and Alternative Therapies Your Hepatitis C Patients May Not Be Discussing With You
Written By Pat F. Bass III, MD on October 6, 2020
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Why Complementary Treatments Are PopularComplementary and alternative medicine (CAM) is popular with patients for many problems and hepatitis C is no exception. CAM is even more popular among patients who have not responded to treatment.
Providers often do not ask about these treatments and patients often do not disclose them. Further, patients often mistakenly assume these treatments are “safe” because they are natural. Often neither providers nor patients are aware of potential interactions with their other treatments. We will focus on several CAM treatments your patients may be using or have tried in the past. It’s important to periodically discuss these practices with your patients. -
Most CAM Treatments Are Marketed as Dietary SupplementsImportantly for the hepatitis C patient, most of these products are marketed as dietary supplements. This means they don’t require FDA approval or require specific testing prior to being made available to the public. Dietary supplement labels may, however, make claims about how the product affects the body clinically. These claims are made without FDA approval since making health claims is a violation of current FDA policy.
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1. Milk Thistle (Silymarin)Milk thistle (prepared from the leaves of the plant Silybum marianum) is the most commonly used CAM herbal treatment for hepatitis C. Putative hepatoprotective mechanisms include antioxidant activity, inhibition of lipid peroxidation, prevention of glutathione depletion, enhanced protein synthesis, antifibriotic activity and anti-inflammatory or immunomodulating effects. Overall, clinical trials have not demonstrated a benefit for liver health. Milk thistle is generally well tolerated, with the most common side effect being mild gastrointestinal distress (bloating, indigestion, nausea, or diarrhea).
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2. Licorice Root (Glycyrrhiza glabra)Licorice is marketed to patients as lozenges, tea, and as parts of dietary supplements. The proposed health benefits surround its anti-inflammatory and antiviral properties. Dietary supplements containing glycyrrhizin—a compound found in licorice root—have been tested in patients with hepatitis C, but there’s currently not enough evidence to determine if they’re helpful.
Glycyrrhizin or licorice can be dangerous in people with a history of cirrhosis, hypertension, kidney failure, diabetes, or cardiovascular diseases. In patients with cirrhosis, mineralcorticoid activity can lead to fluid retention and hypokalemia. When taken over long periods of time and at high doses, side effects are more common. Additional symptoms may include headache, sluggishness and peripheral edema. -
3. ProbioticsMillions of U.S. adults use probiotics on a daily basis. Lactobacillus and Bifidobacterium are the most common bacteria in the various products patients consume. Most patients will take these compounds to help digest food, bolster immune response, destroy disease-causing cells, or produce vitamins or other substances that have a desirable health effect.
While probiotics may be beneficial in the prevention of antibiotic-associated diarrhea from Clostridium difficile and the treatment of ulcerative colitis, they have not shown benefit in hepatitis C. Probiotics can have significant side effects in patients who are significantly immunosuppressed leading to problems such as blood infections. -
4. Colloidal SilverColloidal silver is sometimes cited as a potential treatment for hepatitis C despite a 1999 FDA warning that colloidal silver isn’t safe or effective for treating any disease or condition. Colloidal silver products, containing tiny bits of silver, are primarily liquids to be orally ingested.
Colloidal silver can inhibit absorption of thyroid medications and some antibiotics. Additionally, use of this supplement can lead to a permanent bluish-gray discoloration of the skin known as ardyria. -
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5. Green Tea ExtractGreen tea, made from the leaves of Camellia sinensis, can be concentrated into a green tea extract containing epigallocatechin–3-gallate (EGCG). EGCG is a potent inhibitor of hepatitis C entry into liver cells, has an antiviral component, and may have a role as a chemopreventive agent for hepatocellular cancer.
However, these potential benefits need to be considered alongside a number of serious potential side effects. The medical literature is filled with case reports of liver injury with severe hepatotoxicity, significant morbidity and death. While there are some potential benefits, the hepatotoxic potential must be acknowledged and monitored closely if your patients are going to use this supplement. -
6. Ginger RootGinger root may ease some treatment side effects such as nausea and depression. Ginger root (Zingiber officinale) has been used in Chinese medicine for thousands of years and research has demonstrated its efficacy. It is generally well tolerated but may cause some mild side effects such as abdominal discomfort, heartburn, diarrhea, and gas. If patients are on anticoagulation they will need to be monitored more closely.
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7. St. John’s WortSt. John’s Wort is commonly used as a CAM treatment for depression. It does have antidepressant effects over the short term, but less is known about its long term use and effectiveness. St. John’s Wort can have interactions with anticoagulants, antibiotics, birth control pills, cancer medications, cyclosporine, digoxin, HIV medications. As a result it is important to know what medications your patient is on and if they are utilizing St. John’s Wort.
Combining St. John’s Wort with antidepressants can lead to significant increases of serotonin that can be life threatening. Symptoms occur quickly and can include agitation, diarrhea, tachycardia, hypertension, hallucinations and high fever.
Complementary and Alternative Therapies and Hepatitis C | Healthgrades for Professionals