Alternative and Integrative Therapies for Hepatitis B

Good Scientific Evidence :

Cordyceps : Cordyceps may stimulate the immune system and improve serum gamma globulin levels in hepatitis B patients. Currently, there is insufficient evidence to recommend for or against the use of cordyceps for chronic hepatitis B. However, the results are promising. Additional research of cordyceps and current hepatitis treatments is needed.

Avoid if allergic or hypersensitive to cordyceps, mold or fungi. Use cautiously with diabetes, bleeding disorders or taking anticoagulant medications, with prostate conditions, if taking immunosuppressive medications, or if on hormonal replacement therapy or oral contraceptives. Avoid with myelogenous type cancers. Avoid if pregnant or breastfeeding.

Milk thistle : Multiple studies from Europe suggest benefits of oral milk thistle for cirrhosis. In experiments up to five years long, milk thistle has improved liver function and decreased the number of deaths that occur in cirrhotic patients. Although these results are promising, most studies have been poorly designed. Further research is necessary before a strong recommendation can be made.

In addition, several studies of oral milk thistle for hepatitis caused by viruses or alcohol report improvements in liver tests. However, most studies have been small and poorly designed. More research is needed before a recommendation can be made.

Probiotics : Liver cirrhosis may be accompanied by an imbalance of intestinal bacteria flora. Probiotic supplementation in cirrhosis patients has been found to reduce the level of fecal acidity (pH) and fecal and blood ammonia, which are beneficial changes.

Probiotics are generally considered safe and well tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant.

Unclear or Conflicting Scientific Evidence :

Astragalus : Anti–viral activity has been reported with the use of astragalus in laboratory and animal studies. Limited human research has examined the use of astragalus for viral infections in the lung, heart (pericarditis, myocarditis, endocarditis), liver (hepatitis B and C), cervix (papilloma virus) and in HIV disease. Studies have included combinations of astragalus with the drug interferon or as a part of herbal mixtures. However, most studies have been small and poorly designed. Due to a lack of well–designed research, no firm conclusions can be drawn.

Also, several animal and human studies report that astragalus may protect the liver from damage related to toxins or hepatitis B and C. Overall, this research has been poorly designed and reported. Astragalus alone has not been well evaluated. Better quality research is necessary before a conclusion can be drawn.

Ayurveda : Ayurveda is an integrated system of specific theories and techniques employing diet, herbs, exercise, meditation, yoga and massage or bodywork. Evidence from one well–designed study suggests that the traditional herbal preparation Kamalahar may reduce clinical signs as well as indicators of liver damage in acute viral hepatitis. Kamalahar contains Tecoma undulate, Phyllanthus urinaria, Embelia ribes, Taraxacum officinale, Nyctanthes arbortistis, and Terminalia arjuna.

Another well–designed trial suggests that root powder from the herb Picrorhiza kurroa may improve levels of bilirubin, SGOT (serum glutamic–oxaloacetic transaminase) and serum glutamic pyruvic transaminase (SGPT) in viral hepatitis. Further research is needed before a firm conclusion can be made.

Bupleurum : For more than 2,000 years, bupleurum, has been used in Asia to treat hepatitis, cirrhosis and other conditions associated with inflammation. A high–quality clinical trial and several small recent clinical reports suggest that Bupleurum and/or herbal combination formulae containing Bupleurum may be helpful in the treatment of chronic hepatitis. However, studies to date are small and not all well controlled. Further research is warranted to determine whether Bupleurum can effectively treat hepatitis.

Chicory ( Chichorium intybus ) : Chicory (Chichorium intybus) has been suggested as a possible treatment for chronic hepatitis. However, further research is needed before a definitive conclusion can be made.

Choline : Studies have assessed the use of choline for hepatitis, many of which have been poorly designed. There is insufficient evidence available to determine whether choline can effectively treat hepatitis.

Dandelion : One human study reports improved liver function in individuals with chronic hepatitis B after taking a combination herbal preparation containing dandelion root, called Jiedu Yanggan Gao (also including Artemisia capillaris, Taraxacum mongolicum, Plantago seed, Cephalanoplos segetum, Hedyotis diffusa, Flos chrysanthemi indici, Smilax glabra, Astragalus membranaceus, Salviae miltiorrhizae, Fructus polygonii orientalis, Radix paeoniae alba, Polygonatum sibiricum). Because multiple herbs were used, and this study is not well designed or reported, the effects of dandelion are unclear.

Danshen : Some studies suggest that danshen may provide benefits for treating liver diseases such as cirrhosis, fibrosis and chronic hepatitis B. However, it is unclear whether there are any clinically significant effects of danshen in patients with liver disease.

Eyebright : Limited evidence from animal studies suggests that aucubin, a constituent of eyebright, may inhibit hepatic RNA and protein syntheses in vivo. These properties have been associated with protective effects in carbon tetrachloride and alpha–amanitin–induced hepatotoxicity in mice. Conversion of aucubin to its algycone appears to be a prerequisite step for these hepatic effects to occur. The clinical relevance of these finding to humans is unclear, and there is currently insufficient evidence to determine whether eyebright is an effective hepatoprotective agent.

Germanium : There is limited evidence for the use of propagermanium (an organogermanium) in the treatment of hepatitis B. Additional research is warranted in this area.

Ginseng : There is a lack of sufficient evidence to recommend either American ginseng or Panax ginseng for or against hepatoprotection. One laboratory study investigated compound K, a ginseng metabolite that shows promise in protecting against liver injury. Additional human studies are warranted in this area.

L–carnitine : Although early evidence suggests that L–carnitine may effective treat liver cirrhosis, further research is needed to confirm these results.

Licorice : The licorice extracts DGL and carbenoxolone have been proposed to be possible therapies for viral hepatitis. Further research is needed before a firm conclusion can be made.

Liver extract : Liver extract seems to stimulate liver function. In two studies, liver extract did increase the liver function of patients with impaired liver function. More research is needed to compare liver extract to other hepatostimulatory treatments.

Mistletoe : In a preliminary description in 1997, some patients achieved complete elimination of the virus after treatment with Viscum album, although these studies were not well designed. A small exploratory trial investigated effects of mistletoe on liver function, reduction of viral load and inflammation, and maintaining quality of life by the immunomodulatory and/or cytotoxic actions of mistletoe extracts, but little effect was seen. Larger, well–designed clinical trials are needed to resolve this conflicting data.

Avoid if allergic to plants in the aster family (Compositea, Asteraceae), daisies, artichoke, common thistle or kiwi. Use cautiously with diabetes. Avoid if pregnant or breastfeeding.

Reishi mushroom : Based on positive laboratory evidence, a clinical trial using Ganopoly ® or placebo was conducted in chronic hepatitis B patients. Ganopoly ® treatment decreased levels of hepatitis B virus (HBV) DNA. This virus is notoriously hard to clear from the body and recurrence after treatment is common. Further well–designed research is needed before a firm conclusion can be made.

Rhubarb : Two studies have been conducted on rhubarb and its effects on hepatitis. In the case series, high doses of rhubarb decreased the symptoms and serum levels associated with hepatitis. However, additional, high–quality studies are needed to establish rhubarb's effects.

SAMe : Preliminary evidence from meta–analyses and randomized clinical trials suggests that SAMe may normalize levels of liver enzymes in individuals with liver disease. Well–designed clinical trials, with appropriate subject number in homogenous populations are required before a definitive conclusion can be made in this field.

Selenium : Selenium supplementation has been studied in various liver disorders, including hepatitis, with mixed results. Further research is needed to establish selenium's effects.

Taurine : Early studies have found that taurine supplementation has the potential to modify the conjugation of bile acids, potentially modifying the disease. Furthermore, taurine has been examined as an adjunct to ursodeoxycholate (UDCA) in the treatment of liver disease. Results from these early studies suggest that conjugation of bile acids can be modified and that taurine as an adjunct to UDCA does not offer more benefits. More recent studies are investigating the effect of tauroursodeoxycholate (TUDCA) in liver disease treatment. As of yet, however, the evidence in support of taurine in liver disease is minimal and well–designed clinical trials with positive results are needed before a firm conclusion can be made.

Fair Negative Evidence :

Spirulina : Despite findings indicating potential hepatoprotective properties of spirulina, preliminary human study of spirulina for chronic viral hepatitis shows negative results. Additional high quality study is needed to confirm these findings.

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