Hepatitis is a serious inflammation of the liver. Viral hepatitis, the most common form, usually appears as type A, B, or C. Type B (HBV) and Type C (HCV) affect people of all ages. Hepatitis can result from long-term alcohol abuse, infection, or exposure to various chemicals and drugs.
The different types of hepatitis have many similarities and are therefore discussed here as a whole. If you know that you are infected only with a particular form, you can safely skip to the appropriate sections below.
How does HBV spread?
The spread of HBV occurs when blood from an HBV-infected person enters the body of a person who is not infected. This can occur through having sex with an HBV-infected person without using a condom (the effectiveness of latex condoms in preventing infection with HBV is unknown, but their proper use may reduce spread of HBV).
Sexual contact is the most common reason for the spread of HBV infection in the United States. The spread of HBV from male to female or female to male accounts for about 1 out of 3 acute (recently acquired) HBV infections in adults. The risk of spreading HBV increases if the male or female has multiple sex partners, a history of a sexually transmitted disease, or has sex with an HBV-infected person. About 1 out of 4 acute HBV infections occur among men who have sex with men.
HBV is also easily spread by sharing drugs, needles, or "works" when "shooting" drugs. The risk of HBV infection from HBV-contaminated needlesticks is much greater than the risk of spreading HIV by this method. In the United States, illegal drug use injection accounts for about 16% of acute HBV infections. Other types of percutaneous (through the skin) exposures, including tattooing and body piercing, have also been reported to result in the spread of HBV when good infection control practices have not been used. Unsafe injections in medical settings are a major source of HBV spread in many developing countries and might be a risk for United States residents traveling abroad, if medical care is required in settings that have poor infection control practices.
HBV is also spread through needlesticks or sharps exposures on the job and from an infected mother to her baby during birth. Breastfeeding has not been associated with the spread of HBV.
HBV can also be spread during childhood. Most early childhood spread occurs in households of people with chronic (life-long) HBV infection, but the spread of HBV has also been seen in daycare centers and schools. The most likely way that the spread of HBV occurs during early childhood involves contact between an infected person's body fluids (e.g., their blood or drainage from their wounds or skin lesions) and breaks in the child's skin. HBV can be spread also when an HBV-infected person bites another person who is not infected. HBV can be spread also by an infected person pre-chewing food for babies, and through contact with HBV from sharing personal-care items, such as razors or toothbrushes. The virus remains infectious and capable of spreading infection for at least seven days outside the body. Virus can be found on objects, even in the absence of visible blood.
HBV is not spread through food or water, sharing eating utensils, hugging, kissing, coughing, and sneezing or by casual contact, such as in an office or factory setting. People with chronic HBV infection should not be excluded from work, school, play, childcare, or other settings.
How long can a person with HBV infection spread HBV?
A person with acute or chronic HBV infection is contagious as long as they have the virus in their blood, which can only be determined by blood testing. In general, a person with acute hepatitis B gets rid of the virus in their blood in six months. If this does not happen, it is likely the person will become chronically infected with HBV for life.
Infectious (viral) hepatitis type A (HAV), is the most common hepatitis, often affecting school children. Unlike the other hepatitis types which are seen in all ages equally, hepatitis A in seen mostly in children and young adults.
We are in the midst of an epidemic of Hepatitis B and C infections. Between 1% and 5% of the world's population is infected chronically with one or more of these two viruses. In some parts of the world, such as Egypt and the Far East, up to 15% of the normal population suffer from infections with these viruses. The CDC estimates that 4 million Americans are infected with the hepatitis virus alone.
The following are risk factors for Hepatitis B, which your doctor should be told about:
Receiving a tattoo can also increase your risk of contracting Hepatitis B or C.
Hepatitis A is contagious during the incubation period of 2-6 weeks but only for a few days once symptoms appear.
If hepatitis is suspected, your health care provider will feel and tap your chest and back to determine if your liver or spleen is enlarged or tender. Your provider will request a blood test, possibly a urine test and, in a few cases, a liver biopsy.
The following blood tests are available:
Because hepatitis is potentially very dangerous, a healthcare professional should be involved in its treatment.
Good hygiene is necessary to avoid spreading the infection. People with hepatitis A should wash their hands very carefully after using the restroom and should not handle food at work.
While there is no specific treatment for HAV (most of the treatments mentioned here are for the other types), supportive care is helpful while you fight the infection. Alcohol should be avoided. Coconut milk, not water, is antiviral and said to help in any hepatitis. Bed rest, lots of water, liver supportive herbs such as milk thistle or dandelion would be appropriate.
Numerous nutritional and herbal treatments are available. Items not mentioned elsewhere include:
Examination of liver tissue under the microscope taken from patients with chronic active HCV infection has revealed the presence of NK cells. Indirect evidence for the importance of high NK cell function in limiting chronic hepatitis C infection was demonstrated by two studies of infected patients treated with alpha interferon. Patients that responded clinically to therapy also demonstrated significantly greater enhancement of NK activity than controls after the initial dose of interferon. NK activity was not improved in those who did not respond to treatment, indicating the importance of NK activity.
There are only limited conventional treatments for HCV: it is a disease that can be greatly benefited by natural therapies. Since the persistence of a virus is due in part to lowered immunity, non-toxic immune enhancers (especially those which stimulate NK cell function) should help to resolve or control the infection.
Several nutrients and herbs have been shown to inhibit viral reproduction, improve immune system function, and greatly stimulate regeneration of the damaged liver cells. A therapeutic approach should focus on both immune system enhancement and liver support.
Unlike other white blood cells, inadequate numbers of NK cells are rarely a problem. Instead, it is the activity of the cells that is important. NK activity can be significantly enhanced by natural products or drugs such as IP6 (Inositol hexaphosphate), MGN3 (a commercial rice bran product modified with mushroom extracts), thymus extracts, low dose Naltrexone, zinc, DHEA, glutamine, a good multiple vitamin-mineral over time and others such as astragalus, cordyceps (Chinese fungus), and MCP (modified citrus pectin). NK activity can be impaired by surgery and chemotherapy. Moderate exercise does not depress the immune system, but very strenuous exercise does.
Other treatments that have been beneficial include the use of Vitamin C, liver extracts (which promote hepatic regeneration) and Reishi mushrooms. Licorice root, cysteine and glycine together have produced a 40% cure rate. Silymarin (milk thistle) reverses liver cell damage, increases protein level in the blood, lowers liver enzymes and generally improves symptoms such as abdominal discomfort, decreased appetite and fatigue.
HBV is a known risk factor for primary liver cancer.
Symptoms may include bad breath and bitter taste in the mouth.
Red palms can occur in any chronic liver disease and are not specifically caused by the hepatitis virus. The cause for the redness is unknown, but it is speculated that it may involve upset hormone metabolism or microcirculatory changes.
The hepatitis C virus ranks with alcohol as the major cause of chronic liver disease and cirrhosis in the United States. Infection with this virus causes inflammation of and low grade damage to the liver that over several decades can lead to cirrhosis.
Hepatitis B is probably the most common cause of cirrhosis worldwide, but in the United States and Western world it is less common. Hepatitis B, like hepatitis C, causes liver inflammation and injury that over several decades can lead to cirrhosis.
The hepatitis D virus is another virus that infects the liver, but only in people who already have hepatitis B.
It has been suggested that an impaired TH1 immune response appears to favor chronicity of hepatitis C infections. Whether impaired activity of the NK cells in chronic HCV infections is due to a dominance of TH2 lymphocytes remains to be seen.
While transfusion-related HIV and hepatitis are now relatively rare events, emerging or unknown infections, transfusion errors, and immunomodulation remain compelling reasons to minimize the use of allogeneic transfusion.
Selenium is essential for healthy immune functioning. A large-scale study has shown that selenium supplementation reduces the incidence of viral hepatitis in selenium-deficient populations, presumably by enhancing immune function. [Yu S-Y, Li W-G, Zhu Y-J, et al. Chemoprevention trial of human hepatitis with selenium supplementation in China. Biol Trace Element Res 1989;20: pp.15-20]
Diseases that cause liver damage can lead to increased bilirubin levels. To further investigate the cause of jaundice or increased bilirubin levels, liver function tests or other evidence of infective hepatitis (hepatitis A, B, C, delta, E, etc.) are commonly used.
Thymus extracts help immune system cells to mature and kill the virus as claimed by several clinical reports. Through his clinical experiences with thymic supplementation, Dr. Burgstiner observed that 84 cases of Hepatitis B and 34 cases of Hepatitis C were arrested, as well as the elimination of all traces of Hepatitis B infection in himself. Oral thymus extracts routinely raise thymosin alpha-1 serum levels.
However, thymosin alpha-1 treatment had no biochemical or virological effects in a meta-analysis of five placebo-controlled trials with a total of 353 patients with chronic hepatitis B virus infection. [Aliment Pharmacol Ther 2001;15(12): pp.1899-1905]
Researchers Ikeda, M. et al from the National Cancer Institute in Japan report that bovine lactoferrin directly binds to the HCV and effectively prevented hepatitis C in cultured human hepatocytes cell lines. They report on experiments which show that Lactoferrin directly binds to HCV and not to the infected cells. Other research has confirmed that lactoferrin binds to HCV and a number of other viruses. Lactoferrin is also a natural component of human mother's milk which is also effective against HCV. Lactoferrin is available as an over-the-counter dietary supplement. Adult dosage levels are usually 1000 to 1500mg or more daily. No adverse effects have been reported.
Hepatitis Specific Transfer Factors from colostrum were used in 260 cases and a 100% clinical recovery was reported with no side-effects. Immunological profiles were normalized in approximately half of the individuals at the end of the observation period.
Silymarin (the flavonoid extracted from milk thistle) and silymarin-derived compounds have been considered hepatoprotective (protecting the liver from damage) since the plant was first described in ancient times. More recently, it has been studied for treating all types of liver disease and the results have been encouraging but not yet conclusive due to the lack of large clinical studies.
It has been 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 [Schuppan D, Strösser W, Burkard G, Walosek G. Legalon® lessens fibrosing activity in patients with chronic liver diseases. Zeits Allgemeinmed 1998;74: pp.577-84]. This action makes milk thistle extract potentially attractive to persons with chronic hepatitis C – particularly those who have not responded to standard drug therapy.
For acute hepatitis, double-blind studies have shown mixed results.  A preparation of silymarin complexed with phosphatidylcholine was reported to help sufferers of chronic viral hepatitis. One small pilot study found that at least 420mg of silymarin was necessary each day. A controlled investigation found that silymarin decreased liver damage. One study has suggested that silymarin may be more effective for hepatitis B as opposed to hepatitis C.
Silybum Marianum (80% extract), 200 to 300mg three times per day, protects the liver. It may also be used as phosphatidylcholine-bound silymarin (100 to 150mg three times per day).
 Magliulo E, Gagliardi B, Fiori GP. Results of a double blind study on the effect of silymarin in the treatment of acute viral hepatitis carried out at two medical centers. Med Klin 1978;73: pp.1060-5 [in German]
 Bode JC, Schmidt U, Durr HK. Silymarin for the treatment of acute viral hepatitis? Report of a controlled trial. Med Klin 1977;72: pp.513-8 [in German]
 Vailati A, Aristia L, Sozze E, et al. Randomized open study of the dose-affect relationship of a short course of IdB 1016 in patients with viral or alcoholic hepatitis. Fitoterapia 1993;64:219-27
 Buzzelli G, Moscarella S, Giusti A, et al. A pilot study on the liver protective effect of silybin-phosphatidylcholine complex (IdB 1016) in chronic active hepatitis. Int J Clin Pharmacol Ther Toxicol 1993;31: pp.456-60
 Lirussi F, Okolicsanyi L. Cytoprotection in the nineties: experience with ursodeoxycholic acid and silymarin in chronic liver disease. Acta Physiol Hung 1992;80: pp.363-7
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. [Chaturvedi GN, Singh RH. Jaundice of infectious hepatitis and its treatment with an indigenous drug, Picrorhiza kurroa. J Res Ind Med 1966;1: pp.1-13] A variety of similar reports have appeared in the Indian literature over the years. Between 400 and 1,500mg of powdered, encapsulated picrorhiza per day has been used in a variety of studies.
A tincture of picrorhiza protected rats against oxidation in the liver. [Anandan R, Devaki T. Hepatoprotective effect of Picrorhiza kurroa on tissue defense system in D-galactosamine-induced hepatitis in rats. Fitoterapia 1999;70: pp.54-7] This confirmed earlier evidence suggesting picrorhiza contains antioxidant glycosides. [Chander R, Kapoor NK, Dhawan BN (1992) "Picroliv, picroside-I and kutkoside from Picrorhiza kurroa are scavengers of superoxide anions" Biochem Pharmacol 1992;44: pp.180-3]
Phyllanthus has been studied primarily in carriers of the hepatitis B virus, as opposed to those with chronic active hepatitis. In one study, administering this herb for 30 days appeared to eliminate the hepatitis B virus in 22 of 37 cases (59%) . However, other studies have failed to confirm a beneficial effect of Phyllanthus amarus against hepatitis B  .
A West Indian species, Phyllanthus urinaria (not widely available in the United States or Europe), has achieved much better results than Indian Phyllanthus amarus. Thus, the specific plant species used may have a significant impact on the results. The recommended dosage is 200mg, three times per day.
 Thyagarajan SP, Subramian S, Thirunalasundari T, et al. Effects of Phyllanthus amarus on chronic carriers of hepatitis B virus. Lancet 1988;2: pp.764-6
 Doshi JC, Vaidya AB, Antarkar DS, et al. A two-stage clinical trial of Phyllanthus amarus in hepatitis B carriers: Failure to eradicate the surface antigen. Indian J Gastroenterol 1994;13: pp.7-8
 Leelarasamee A, Trakulsomboon S, Maunwongyathi P, et al. Failure of Phyllanthus amarus to eradicate hepatitis B surface antigen from symptomless carriers. Lancet 1990;335: pp.1600-1
 Wang M, Cheng H, Li Y, et al. Herbs of the genus Phyllanthus in the treatment of chronic hepatitis B: observations with three preparations from different geographical sites. J Lab Clin Med 1995;126: pp.350-2
Usually used with Phyllanthus.
Recommended dosage is 250 to 500mg, three times per day. Do not take licorice if you have high blood pressure. One of the active constituents in licorice, glycyrrhizin, is commonly used in Japan as an injected therapy for hepatitis B and C.  Glycyrrhizin also blocks hepatitis A virus from replicating in test tubes. It is not known whether oral licorice extracts that are high in glycyrrhizin are effective against hepatitis.
250 to 500mg three times daily. Combine with Bromelain (250 to 500mg three times per day between meals) to enhance its effects.
Small, frequent meals are suggested to optimize digestion.
A more vegetarian diet is naturally lower in saturated fats (meat and dairy products) and higher in grains, vegetables, fruits, vegetable proteins (legumes such as soy), and essential fatty acids (cold-water fish, nuts, and seeds) that are all recommended for Hepatitis. Foods that support the liver are beets, artichokes, yams, onions, garlic, green leafy vegetables, apples, and lemons.
Simeprevir (approved in 2013 and sold under the names Olysio, Sovriad, Galexos) is a medication used in combination with others to treat hepatitis C genotype 1 and 4 with cure rates of 80-90%. Unfortunately, at the time of writing (late 2017), the cost was a prohibitive $150,000 for a 12-week course. Danoprevir in 2017 was a clinical candidate based on its favorable potency profile against multiple HCV genotypes 1-6 and key mutants. Both of these drugs were developed by exploiting earlier (abandoned) research on Ciluprevir.
Previously, Reuters had reported on Oct 27, 2003 that scientists working for Boehringer Ingelheim in Germany developed a drug that could offer new hope. Ciluprevir, originally developed under the research code of BILN 2061, targets an enzyme to block the replication of the virus. In eight people given four doses of the treatment, the amount of virus in the blood (viral load) dropped by 100 to 1,000-fold after 48 hours without producing any unpleasant reactions. BILN 2061 was the first of a class of drugs called NS3 protease inhibitors to be tested in humans.
Unfortunately, although BILN 2061 demonstrated potent antiviral activity against HCV genotype 1, the virologic response was less pronounced and more variable in HCV genotype 2 and 3 patients. Despite early enthusiasm, further development was halted due to concerns related to potential cardiotoxicity in animal models.
A study with Amantadine was performed at the Department of Medicine at the Milton S Hershey Medical Center by JP Smith on patients who had previously failed interferon-alpha 2b therapy. It found that in 22 patients with chronic hepatitis C given 100mg twice daily for an average of 32 months[Dig Dis Sci 1997 Aug;42(8): pp.1681-7], 64% of the patients had decreases in ALT values with 27% having normalization of ALT values and a loss of HCV RNA as measured by PCR. No side effects were reported.
Optimal selenium status should be ensured for both prevention and treatment: 200mcg per day is needed to keep your liver healthy. When the micronutrient selenium was added to the diet of 20, 847 people in a Chinese town, the number who became infected with hepatitis B virus was 50% less than for villagers not receiving dietary selenium. Supplementation also markedly reduced the risk of liver cancer among HBV sufferers.
"Selenium also appears to be protective in individuals infected with hepatitis virus (B or C) against the progression of the condition to liver cancer." [Rayman MP. The importance of selenium to human health. The Lancet. July 15, 2000; volume 356, pp.233-41]
Some viruses are much more susceptible to ozone's action than others. It has been found that lipid-enveloped viruses such as HBV and HCV are among the most sensitive. While many doctors are reporting good success in treating Hepatitis with ozone, there have been limited studies performed.
In a small trial of 8 patients in which post treatment follow-up information was available, viral loads by Polymerase Chain Reaction, taken at the onset of ozone therapy, then repeated following completion of the therapy, were compared. An average viral load reduction of 99.96% was achieved. At the onset of treatment 7 of the 8 patients also had elevated liver enzyme levels – SGOT (AST) and SGPT (ALT). Following ozone therapy these measures fell into the normal range. This pilot trial, without a blind control group and conducted in an offshore setting, must be viewed as anecdotal although fully consistent with the experience of many.
Alpha lipoic acid is given in a dose of 300mg at least twice per day for hepatitis B or C. Alpha lipoic acid (ALA), silymarin, and selenium have been used in combination with success in reducing symptoms and elevated liver enzyme levels (though the viral load was not substantially reduced).
Taking 3gm per day of phosphatidylcholine (found in lecithin) was found to be beneficial in one investigation of people with chronic hepatitis B. Signs of liver damage on biopsy were significantly reduced in this study. [Jenkins PJ, Portmann BP, Eddleston AL, Williams R. Use of polyunsaturated phosphatidylcholine in HBsAg negative chronic active hepatitis: Results of prospective double-blind controlled trial. Liver 1982;2: pp.77-81]
Catechin has helped people with acute viral hepatitis , as well as individuals with chronic hepatitis , though not all studies have found a benefit. A typical amount used in successful trials is 500-750mg three times per day.
 Blum AL, Doelle W, Kortum K, et al. Treatment of acute viral hepatitis with (+)-cyanidanol-3. Lancet 1977;2: pp.1153-5
 Suzuki H, Yamamoto S, Hirayama C, et al. Cianidanol therapy for HBs-antigen-positive chronic hepatitis: a multicenter, double-blind study. Liver 1986;6: pp.35-44
 Bar-Meir S, Halpern Z, Gutman M, et al. Effect of (+)-cyanidanol-3 on chronic active hepatitis: A double blind controlled trial. Gut 1985;26: pp.975-9
Vitamin E levels have been shown to be low in people with hepatitis , as well as in those who go on to develop liver cancer from long-standing hepatitis. Vitamin E levels in the liver may also be decreased in some people with hepatitis.
In a study of individuals with hepatitis B, half received 600 IU of vitamin E per day for nine months, while the others received no vitamin E (control group). In five of the twelve people receiving vitamin E (compared with none of those in the control group), all signs of hepatitis disappeared.
In a study 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. In a preliminary study 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. However, in children with viral hepatitis, daily injections of vitamin E (300 IU) for seven days did not produce any benefit.
 Von Herbay A, Stahl W, Niederau C, et al. Diminished plasma levels of vitamin E in patients with severe viral hepatitis. Free Radic Res 1996;25: pp.461-6
 Pan WH, Wang CY, Huang SM, et al. Vitamin A, vitamin E or beta-carotene status and hepatitis B-related hepatocellular carcinoma. Ann Epidemiol 1993;3: pp.217-24
 Mezes M, Par A, Nemeth P, Javor T. Studies of the blood lipid peroxide status and vitamin E levels in patients with chronic active hepatitis and alcoholic liver disease. Int J Clin Pharmacol Res 1986;6: pp.333-8
 Andreone P, Gramonzi A, Bernardi M. Vitamin E for chronic hepatitis B. Ann Intern Med 1998;128: pp.156-7
 Houglum K, Venkataramani A, Lyche K, Chojkier M. A pilot study of the effects of d-alpha-tocopherol on hepatic stellate cell activation in chronic hepatitis C. Gastroenterology 1997;113: pp.1069-73
 Look MP, Gerard A, Rao GS, et al. Interferon/antioxidant combination therapy for chronic hepatitis C – a controlled pilot trial. Antiviral Res 1999;43: pp.113-22
 Yurdakok M, Kanra G. Vitamin E therapy in viral hepatitis. Mikrobiyol Bul 1986;20: pp.91-4 [in Turkish]
Vitamin B12 (with or without folic acid) has been reported in studies from the 1950s to help some people with hepatitis.  Vitamin B12 injections are likely to be more beneficial than oral administration, though 1,000mcg taken orally each day can also be supplemented.
 Campbell RE, Pruitt FW. Vitamin B12 in the treatment of viral hepatitis. Am J Med Sci 1952;224: pp.252-62
 Campbell RE, Pruitt FW. The effect of vitamin B12 and folic acid in the treatment of viral hepatitis. Am J Med Sci 1955;229: pp.8-15
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