Hepatitis

DESCRIPTION

 

An inflammation of the liver, hepatitis can be caused by many drugs and toxic chemicals, but in most instances, is caused by a virus. The most common hepatitis viral types are A, B, and C. Other less common viral causes of hepatitis include hepatitis viruses D, E, and G, as well as herpes simplex virus, cytomegalovirus, and Epstein–Barr virus. Hepatitis A is transmitted primarily through fecal contamination.
Groups most at risk for hepatitis A infection are international travelers, persons living in American Indian reservations or Alaska Native villages, homosexually active men, and injecting drug users. The Centers for Disease Control (CDC) estimates 125,000– 200,000 infections with hepatitis A occur annually in the  United States, and that 33% of Americans have evidence of past infection (immunity). Approximately two thirds (84,000–134,000) of hepatitis infections are symptomatic. Hepatitis A typically surfaces in large nationwide outbreaks every decade or so (the last outbreak occurred in 1989). Although hepatitis A does not evolve into chronic infection, it is responsible for 100 deaths each year in the US, and prolonged or relapsing hepatitis develops in 15% of cases.

Hepatitis B, which is shed in saliva, semen and vaginal secretions, is transmitted through sexual contact and also through infected blood or blood products. Hepatitis B can live on dry surfaces for at least 7 days; it is one of the most communicable diseases and the ninth cause of death worldwide. According to the CDC, approximately 1.25 million Americans are carriers of hepatitis B; 140,000–320,000 new cases are reported each year, about half of which (70,000–160,000) are symptomatic, and 70% of which occur in individuals between the ages of 15 and 39 years. In addition, 22,000 pregnant women are infected with hepatitis B and can transmit it to their newborns. About 93% of adults who contract hepatitis B recover within 6 months, but approximately 5–10% of adults and 75–90% of children under the age of 5 years who are infected with hepatitis B are unable to clear the virus within 6 months and are considered chronically infected.

Hepatitis C is primarily blood-borne but can also be transmitted sexually and by an infected mother to her
newborn. Hepatitis C is responsible for roughly 90% of all cases of hepatitis contracted through blood transfusions. In the past, before the blood supply was checked for hepatitis, approximately 10% of persons receiving blood transfusions developed hepatitis C. Now, only 4% of hepatitis C cases are the result of transfusions; 60% of cases are due to illegal intravenous drug use. According to the CDC, 3.9 million Americans have been infected with hepatitis C, of whom 2.7 million are chronically infected. Of this group, 70% will develop serious liver damage, and 20–30% of these will develop liver cancer or liver failure requiring a liver transplant. Hepatitis C contributes to the deaths of 8,000–10,000 Americans each year, a much higher mortality toll than other forms of hepatitis, and one that is expected to triple by 2010 and exceed the number of annual deaths due to AIDS.

 
FREQUENT SIGNS AND SYMPTOMS

As noted above, a large percentage of hepatitis infections are asymptomatic.

 
Early stages

Symptoms occur 2 weeks to 1 month before liver involvement, depending upon the virus’ incubation period.

• Flu-like symptoms
• Fatigue
• Intermittent nausea
• Abdominal pain
• Vomiting
• Loss of appetite

Several days later

• Jaundice (yellow eyes and skin) caused by a buildup of bile in the blood
• Dark urine due to elevated bilirubin levels
• Light, “clay-coloured” whitish stools
• Tender, enlarged liver
• Fever

Laboratory findings

• Normal-to-low white blood cell count
• Markedly elevated liver enzymes (enzymes such as SGPT, GGPT, SGOT, and alkaline phosphatase leak into the blood when liver cells are damaged)
• The type of virus is determined by identifying viral antigens (compounds recognized as being foreign to the body), or antibodies (defensive molecules specifically developed by the immune system to bind to the antigens).

Chronic Hepatitis B or C

• Symptoms may be virtually non-existent
• Chronic fatigue
• Serious liver damage, including cirrhosis of the liver or liver cancer
• Chronic hepatitis B infection is monitored by continued blood evaluation of antibody levels
• Hepatitis C is monitored, in addition to liver enzymes, by the presence of the hepatitis C viral-RNA by polymerase chain reaction. The higher the level of HCVRNA, the more aggressive the chronic infection.

CAUSES

• Types A and E: poor sanitation; consumption of water or food, especially raw shellfish, which has been contaminated by sewage.
• Type B: usually sexually transmitted through contact with the body fluids of an infected person, through contaminated blood transfusions, or from injections with non-sterile needles or syringes. An infected mother can pass it on to her newborn.
• Type C: usually transmitted through intravenous drug use, blood transfusions and other exposures to contaminated blood and blood products. In 40% of cases, mode of transmission is unknown.
• Type D: always associated with hepatitis B infection.
• Type G: usually blood-borne, similar to Type C.

RISK INCREASES WITH

Hepatitis A

• Travel to areas with poor sanitation or regions with endemic hepatitis A (American Indian reservations, Alaska Native villages)
• Children of immigrants from disease-endemic areas
• During outbreaks – day care centers or residential programs
• Poor nutrition
• Lowered resistance due to other illness

Hepatitis B and C

• Children of immigrants from disease-endemic areas
• Infants born to infected mothers
• Health care workers – hospital, dental
• Heterosexuals with multiple sex partners
• Homosexually active men
• Oral–anal sexual practices
• Injecting drug users
• Hemodialysis (kidney dialysis) patients
• Poor nutrition
• Lowered resistance due to other illness

Hepatitis C

• Blood transfusions before July 1992
• Recipient of clotting factors made before 1987

PREVENTIVE MEASURES

• When possible, avoid risks listed above.
• Vaccination: recommended for individuals in high risk occupations, such as members of the medical and dental field who are regularly exposed to blood and other body fluids, and individuals travelling to disease endemic areas or areas with poor sanitation.
• HBIG (hyperimmune globulin) injection: in the case of acute exposure to hepatitis B (HBV), HBIG – a concentrated solution of immune globulins specific to HBV – is administered by injection. HBIG confers immediate but short-lived (3 months) immunity. Two doses given within 2 weeks of exposure confer protective immunity in 75% of exposed individuals.
• Newborns whose mothers are positive for hepatitis surface antigen (HBsAG) should receive HBIG vaccine (0.5 ml) shortly after birth, at 3 months, and at 6 months.
• Anyone sexually exposed to someone with hepatitis should seek medical advice about receiving HBIG injections.
• If suffering from hepatitis or caring for someone with hepatitis, hands should be washed carefully and often, especially after bowel movements.
• An individual with hepatitis should have separate eating and drinking utensils or use disposable ones.

Expected outcomes

Acute hepatitis

• Acute viral hepatitis can be an extremely debilitating disease requiring bed rest.
• Jaundice and other symptoms peak and then gradually disappear over 3–16 weeks.
• Most people in good general health recover completely in 1–4 months (usually by 9 weeks for type A and 16 weeks for types B, C, D, and G). However, liver failure, cirrhosis of the liver, liver cancer, and even death are possible outcomes.
• Death occurs in approximately 1 : 100 infected individuals.

Chronic hepatitis

• Currently, 10% of hepatitis B and 10–40% hepatitis C cases develop into chronic hepatitis.
• Hepatitis C contracted from a transfusion is associated with a 70–80% chance of developing into chronic hepatitis.
• Persons with chronic hepatitis may look well and not realize they are infected, but they are potentially infectious carriers to their household and sexual contacts.

TREATMENT

Diet

Acute phase

• Do not drink alcohol. Alcohol stresses detoxification processes and can lead to liver damage and immune suppression.
• Ensure adequate fluid intake by consuming a minimum of 8 glasses of fluid per day: water, vegetable broths, diluted vegetable juices (diluted by half with water), herbal teas.
• Restrict solid foods to brown rice, steamed vegetables, and moderate intake of lean protein sources, e.g., legumes, fish.

Chronic Phase

Avoid:

• Alcohol – the most common cause of impaired liver function.
• Saturated fats (animal products) – these increase the risk of fatty infiltration of the liver or cholestasis, a condition in which the excretion of bile (a carrier substance for toxins) is inhibited.
• Simple carbohydrates (sugar, white flour, [processed  foods containing sugar and/or white flour], fruit juice, honey, maple syrup, etc.) – simple carbohydrates suppress immune function.
• Oxidized fatty acids (fried foods, refined oils) – these damaged fats cause cellular damage and contribute to cholestasis
• Foods containing iron – hepatitis C combines with iron molecules to form potent free radicals that seriously damage liver cells.

Choose:

• A high-fiber diet based on plant foods.
• Foods rich in factors that help protect the liver from damage and improve liver function, including:
  high-sulphur content foods – garlic, legumes, onions, eggs
  foods containing water-soluble fibers – pears, oat bran, apples, legumes
  cabbage-family vegetables – broccoli, Brussels sprouts, cabbage
  artichokes, beets, carrots, dandelion
  herbs and spices – turmeric, cinnamon, licorice

Nutritional supplements

• A high-potency, iron-free, multiple vitamin and mineral supplement:
• Includes antioxidant vitamins such as vitamin C, beta-carotene, and vitamin E, which help protect the liver from damage.
• Includes B vitamins, calcium and trace minerals, which are critical in the elimination of toxic compounds from the body.
• Is iron-free: iron promotes hepatitis-induced liver injury.
• Vitamin C: Robert Cathcart MD has demonstrated, and other studies have confirmed, that high doses of vitamin C greatly diminish acute viral hepatitis in 2–4 days, with jaundice clearing within 6 days:
• When hospitalized patients (at higher risk for exposure to hepatitis) received high levels of vitamin C they did not develop hepatitis, while 7% of the control patients (who received less) did.
• Selenium: a cofactor in the production of glutathione (a critically important antioxidant and detoxifying agent in liver cells), selenium has been shown to reduce the incidence of hepatitis B and C:
• Epidemiological studies: in areas of China with high rates of hepatitis B and primary liver cancer, high levels of dietary selenium significantly (35%) reduced hepatitis B infection and liver cancer incidence (in a group of 226 hepatitis B positive people, selenium supplementation reduced liver cancer incidence to zero).
• Animal studies: selenium supplementation reduced hepatitis B infection by 77.2% and precancerous liver lesions by 75.8%.
• N-acetylcysteine (NAC): an amino acid that, along with selenium, is a key component of glutathione;
• Alpha-lipoic acid: alpha-lipoic acid is an extremely powerful antioxidant that scavenges hydroxyl radicals (the most dangerous type of free radicals found in the body), chelates (binds and removes) heavy metals, recycles other antioxidants, and induces significantly increased intracellular levels of glutathione:
• In recent studies, when alpha-lipoic acid was added to various types of animal and human cells in tissue culture, including liver and kidney cells, it caused a 30–70% increase in cellular glutathione levels.
• Liver extracts: numerous scientific investigations into the therapeutic effectiveness of liver extracts have demonstrated that they promote liver regeneration and are very effective in treating chronic liver disease, including hepatitis.
• Thymus extracts: thymus extract induces broad spectrum immune enhancement via improving the activity of the thymus gland, the master gland of the immune system:
• In several double-blind studies of acute and chronic type B viral hepatitis, thymus extracts produced accelerated decreases of liver enzymes, elimination of the virus, and a higher rate of formation of anti- HBe (the antibody against hepatitis B), signifying clinical remission.

Botanical medicines

• Glycyrrhiza glabra (licorice): licorice exerts a variety of beneficial actions in chronic as well as acute hepatitis treatment, including: protecting the liver; enhancing the immune system; boosting interferon (the body’s own antiviral and immune-enhancing agent); and promoting the flow of bile to and from the liver:
  Caution: in susceptible individuals, licorice has blood pressure elevating effects:
  Adverse effects are rarely seen at levels below 100 mg q.d., but are common at levels above 400mg q.d.
  Prevention of side effects may be possible by following a high-potassium, low-sodium diet. Patients who normally consume high-potassium foods and restrict sodium intake, even those with high blood pressure and angina, are typically free from the blood pressure elevation side effects of licorice.
  To ensure safety, licorice should probably not be used by patients with a history of hypertension or renal failure, or who are currently using digitalis preparations.
  If licorice is used in treatment of chronic hepatitis, intake of potassium-rich foods must be increased.
• Silybum marianum (milk thistle): milk thistle contains silymarin, a mixture of flavonoids that is one of the most potent liver-protecting substances known. Silymarin has been found to be dramatically effective in reversing liver damage and in treating both acute and chronic hepatitis. Silymarin inhibits liver damage by:
  Acting as a direct antioxidant and free radical scavenger
  Increasing intracellular levels of glutathione and superoxide dismutase, two critically important liver antioxidants and detoxifying agents
  Inhibiting the formation of leukotrienes (agents that promote inflammation and free radical generation)
  Increasing bile flow
  Stimulating liver cell regeneration
• Silymarin phytosome: research indicates that this new form of silymarin, which is bound to phosphatidylcholine, is better absorbed and produces better and more rapid clinical results than unbound silymarin.

Drug–herb interaction cautions

• Glycyrrhiza glabra (licorice):
  Plus digoxin, digitalis: due to a reduction of potassium in the blood, licorice enhances the toxicity of cardiac glycosides. Interaction with these cardioglycoside drugs could lead to arrhythmias and cardiac arrest.
  Plus stimulant laxatives or diuretics (thiazides, spironolactone or amiloride): licorice should not be used with these drugs because of the additive increase of potassium loss to potentially dangerous levels.

ICIM Medics Approach

If you feel that this article relates to you and you suspect that Hepatitis may be present, then please make an appointment to see one of ICIM Medics medical team members.

This article is not meant to be used for treatment but for information purposes only. If you feel that this approach is appropriate for you please contact ICIM Medics on 045 844 819 or www.icim.ie e-mail : info@icim.ie  An appointment can be arranged for you.

Tags: Hepatitis A, Hepatitis B, Hepatitis C