The philosophy of naturopathic medicine can best be described as the utilization of the healing power of nature. Several basic thoughts are at the core of this philosophy. Naturopathic health care providers approach health with prevention and education foremost in their minds. If disease enters the picture, the approach is to treat the whole person so that the natural healing powers of the body can rid it of the root cause of the illness.

The Naturopathic Approach

Naturopathic health care providers use many different tools in the care and treatment of patients. These include botanical medicines (herbs), acupuncture, nutritional supplements, traditional Chinese medicine, homeopathic remedies, nutrition counseling and diet therapy, massage and/or spinal manipulation, exercise, and other forms of therapy.

There are four accredited naturopathic medical colleges in the United States. If you choose to include naturopathic medicine in your treatment of hepatitis C, it is important that you see a licensed naturopathic doctor. The American Association of Naturopathic Physicians provides information on well-trained, naturopathic doctors in the United States (see the Resource Directory).

The Principles of Naturopathic Treatment for Hepatitis C

The following is a discussion of the naturopathic approach to treating hepatitis C and the options a naturopathic doctor might consider when treating someone with hepatitis C.

The Liver as an Organ of Detoxification

The liver is a large organ; it weighs about 3½ pounds. It requires approximately one-third of the heart’s output of blood to do its many jobs. The liver filters almost two quarts of blood every minute. This filtration is essential to the body’s survival because the liver receives blood directly from the intestines. The liver filters proteins and other nutrients and chemicals from the food we eat. The liver regulates blood sugar levels, stores fat soluble vitamins, activates and breaks down hormones and drugs, and aids in the elimination of pollutants and toxins from disease causing microorganisms. The liver also manufactures nutrients, enzymes, and hormones.

For the liver to function well, it needs certain nutrients for the detoxification system and immune cells. The liver requires B vitamins (B2, B3, B6, B12, and folic acid), magnesium, zinc, copper, choline, betaine, and the amino acids methionine, taurine, and cysteine to break down medications, pollutants, and chemicals found in air, water, and food.¹

Glutathione

Glutathione is one of the most important chemicals needed for liver health. Glutathione is an antioxidant, a chemical that protects the liver from damage by other chemicals called free radicals and oxidants. Glutathione is produced in the liver and elsewhere in the body from some of the nutrients listed above. Glutathione is a sulfur-based peptide (a protein precursor) that helps the liver eliminate free radicals and metabolize (break down) medications and chemicals. Glutathione is used by many types of cells as the main antioxidant defense against oxidative stress (an overabundance of free radicals). It is also a crucial activator of certain immune system cells called cytotoxic T-cells. Cytotoxic T-cells kill viruses and cancer cells. ²

The body cannot function without glutathione. Loss of glutathione causes liver and kidney failure, and ultimately death. Low glutathione levels are found in people with cataracts, HIV infection, chronic hepatitis C, and cirrhosis. ³ People with cirrhosis of the liver may have difficulty making glutathione. This may explain why glutathione levels are 30% below normal in people with cirrhosis. ⁴

Because glutathione acts as an antioxidant and prevents damage from oxidants such as iron, it may slow the fibrosis process. Damage from liver iron is a contributing factor in the process of fibrosis. Levels of the most important form of glutathione (reduced glutathione) are significantly below normal in people who have alcoholic hepatitis or hepatitis C.^5,6 Studies have shown that people with hepatitis C who had the lowest glutathione levels also had the highest viral loads and more evidence of liver damage.⁶ Glutathione has been shown to have direct antiviral effects. Although no research has been done with the hepatitis C virus (HCV), glutathione has been shown to inhibit HIV in the test tube. ⁷ Although this research does not prove that raising glutathione levels leads to lower viral loads, it does indicate that optimal levels of glutathione may be an important factor in controlling HCV infection.

Limiting Exposure to Liver Damaging Substances and Situations

People with HCV should avoid exposure to anything that can cause additional damage to the liver. Following are examples of substances that may place additional stress on and possibly damage your liver.

Alcohol

Chronic alcohol consumption is a significant risk factor for liver cirrhosis. Chronic alcohol drinkers who do not have HCV are actually at a higher risk of developing cirrhosis than those who do have hepatitis C but do not drink.⁸ Among people with HCV, the risk of developing cirrhosis is about 16 times higher in chronic drinkers than in those who do not drink alcohol. It is important to remember that even low levels of alcohol consumption (less than 6 ounces per week) are related to higher HCV viral loads and increased liver fibrosis. ⁹ National consensus conferences of doctors and scientists in France and the United States have recommended that all people with hepatitis C refrain from drinking any alcohol. ¹⁰

Alcohol damages the liver by depleting it of glutathione. Even in people who have HCV without symptoms and only mild elevations in liver enzymes, liver damage may still exist and the damage is worsened by loss of glutathione due to alcohol use.

Acetaminophen

The over-the-counter medicine acetaminophen (APAP, Tylenol^®) can deplete the liver of glutathione.¹¹ Because glutathione levels may already be low in people with HCV, risking even lower levels with long-term acetaminophen use may be unwise. Use of acetaminophen for a headache every now and then will not affect liver glutathione levels, but daily use of this medicine over months can deplete the liver's store of glutathione. Acetaminophen is the active ingredient in many over-the-counter pain relievers. It is also found in many cold remedies and prescription pain medications. If you need a pain reliever, ask your health care provider about alternatives to acetaminophen that provide similar pain relief. Naturopathic doctors prescribe botanical medicines for pain relief such as food extracts and herbs. Examples include Bromelain (an enzyme extracted from pineapples), Picrorhiza kurroa extract, Boswellia serrata extract, Curcuma longa (a turmeric root extract), and Salix alba (white willow bark).

Tobacco and Recreational Drugs

The liver must break down all the toxic and carcinogenic compounds found in tobacco, marijuana, and other recreational drugs. Marijuana contains many of the same carcinogenic compounds as tobacco. Both tobacco and marijuana use increase the risk of liver cancer for people infected with HCV.¹² If you feel you need to use marijuana for pain relief or to stimulate your appetite, try alternative pain relievers and other strategies for increasing your appetite. If you feel you must use marijuana, use as little as possible.

Coffee

Although caffeine appears to pose no problem for the liver in chronic hepatitis C, there are other substances in coffee that have been shown to raise liver enzyme levels in healthy people. Research has been conducted on two compounds found in coffee beans, cafestol and kahweol (called diterpenes). One study found these compounds raised ALT levels by 80% in 46 healthy subjects who were drinking 5-6 cups of strong, French press (unfiltered) coffee daily.¹³ ALT levels dropped to 45% above normal 24 weeks after the study participants stopped drinking coffee. However, the authors concluded they could not rule out the possibility that the coffee had caused subclincal (something that happens but cannot be seen through blood analysis or symptoms) injury to participants’ liver cells.

Other studies have shown that cafestol and kahweol raise blood cholesterol, triglyceride, and low-density lipoprotein (a harmful fat) levels, and increase other risk factors for heart disease.¹⁴ Filtering coffee eliminates both cafestol and kahweol. However, because they are not filtered, espresso or French press coffee contain both of these compounds. If you are a coffee drinker, make sure you drink filtered coffee. Drinking water-processed, decaffeinated, filtered coffee decreases any potentially harmful effects coffee may have.¹⁵

Occupational Exposures

Exposure to pesticides, herbicides, and other chemicals can cause liver damage and elevation of liver enzymes.^16-18 If your job exposes you to chemicals, solvents, fumes, pesticides, or herbicides, it is very important that you use OSHA-approved protective gear to prevent breathing the fumes or having physical contact with these chemicals. This includes exposure to paint and lacquer, solvents such as dry cleaning fluid, glues and epoxy, fabric coatings, and many others. If you have a history of chemical exposure and are concerned about the effects on your liver, there are proven ways to reduce the burden of these toxic compounds on your body. Elimination of these toxic compounds requires the supervision of a trained doctor. Naturopathic doctors and medical doctors trained in environmental medicine can supervise programs designed to eliminate these substances from the body. The Encyclopedia of Natural Medicine was written by licensed naturopathic doctors and is a good resource for information about naturopathic support for detoxification.¹⁹

Diet and Hepatitis C

One of the basic concepts of a naturopathic diet is the inclusion of only minimal amounts of processed foods and simple sugars (sucrose, glucose, corn syrup, etc.). This recommendation is based on research that examined the effect of large amounts of simple sugars on the immune system. Eating 75-100 grams (approximately 2.5-3.5 ounces) of white sugar, honey, or fruit juice appears to reduce the ability of specific white blood cells to attack foreign organisms such as viruses and bacteria by 50%.^20,21 This immune suppressing effect starts 30 minutes after eating, and lasts for five hours afterward. Since the average American eats and drinks 175 grams of sugar daily, the potential effect on the immune system is considerable. The immune system is an important factor in hepatitis C. We know that those who clear HCV appear to have lymphocytes (white blood cells) that are better able to kill the virus than those who go on to become chronically infected. ²²

Dietary Fat

The only available research on diet that relates directly to HCV infection is a study that examined how dietary fat, carbohydrate, and protein levels affect the risk for disease progression to cirrhosis. The study indicated a high-fat diet coupled with low amounts of protein and carbohydrates increases the risk of progressing to cirrhosis. ²³ However, the study did not indicate what specific types of fat may be dangerous.

As explained in Chapter 7, Nutrition and Hepatitis C, not all fats are bad. Omega-3 fatty acids actually have helpful immune regulating effects and should always be included in a nutritional plan for optimizing the immune system. Some types of fat actually appear to be beneficial for people with hepatitis C. Studies of phosphatidylcholine, a type of fat found in fish and soybeans, showed it has a beneficial effect in reducing liver enzymes and increasing the response rate to interferon. ²⁴ People who were given polyunsaturated phosphatidylcholine (1.8 grams/day) during treatment with interferon and for six months following treatment had significantly fewer relapses than those who did not take the fat supplement. Forty-one percent of the patients in the phosphatidylcholine group had a sustained response compared to 15% who received only interferon. Different forms of phosphatidylcholine have been used in hepatitis resulting from alcoholism, and have been effective in decreasing fibrosis. ²⁵

For a thorough discussion of the fundamentals of a naturopathic approach to eating a healthy diet, see Chapter 7, Nutrition and Hepatitis C.

Nutritional Supplementation

A nutritious diet, nutritional supplementation, and botanical medicines are the foundations of the naturopathic approach to treating chronic hepatitis C. The nutritional supplements listed in Chapter 16, Nutritional Supplementation are mostly antioxidants. They work to decrease liver inflammation and raise glutathione levels. Glutathione is an important antioxidant and immune system regulator. The supplements listed in Chapter 16, Nutritional Supplementation are meant to be taken together as a total protocol, not as substitutes for each other or as choices that can be taken individually. As stated in Chapter 7, Nutrition and Hepatitis C, neither diet alone nor supplements alone are enough to help the body effectively manage chronic hepatitis C.

Botanicals Used To Treat Hepatitis C Liver Problems

Drug-Herb Interactions

Most active substances in medicines and botanicals are processed (metabolized) by either the liver or the kidneys. It is important to realize that whenever you are taking more than one medication or botanical, there is a potential for interaction between the active ingredients. The potential for interactions applies to all medications (prescription drugs and over-the-counter formulations) and all botanicals (supplied by a health care practitioner or purchased over-the-counter).

For the purposes of this discussion, all prescription medications, over-the-counter remedies, individual herbs, and botanical preparations are considered and will be referred to as "drugs."

Drug-herb interactions fall into four categories:

altered absorption

Drugs taken by mouth must be absorbed into the blood through the stomach and intestines. Two or more substances taken together can affect absorption in several different ways. Drugs taken together may bind to one another and decrease the overall absorption of both substances. Substances that affect the acidity in the stomach can also alter the absorption of other drugs. Any drug that has a laxative effect may decrease the absorption of other drugs taken by mouth. The important concept to understand is that two or more substances taken together may alter the amounts of active ingredients absorbed by the body.

altered renal (kidney) elimination

Some drugs are eliminated from the body primarily by the kidneys. They are excreted in the urine. When two or more medicinal substances that are eliminated by the kidneys are taken at the same time, the kidneys may be overwhelmed. Toxic amounts of one or more substances may build up in the bloodstream, especially if there is underlying kidney damage or if one of the drugs decreases normal kidney function.

additive effects or toxicities

Medicinal substances often have similar effects on the body. Some of these effects are beneficial, but others are toxic. Two medicinal substances that interact with one another in a similar way are said to have pharmacodynamic interactions. These interactions can be additive or neutralizing (see Figure 1). For example, ribavirin and certain anti-HIV medicines can cause anemia. When ribavirin is given along with one of these anti-HIV medications, anemia is more likely to occur than when either drug is given alone. Herbs and drugs can also have pharmcodynamic interactions. Even when two medicinal substances have the same beneficial action individually, combining the two may be detrimental. For example, a mild laxative may be helpful if you're having trouble moving your bowels. But combining a mild laxative with an herb that also has a laxative effect may cause diarrhea. Two medicinal substances with opposite actions may cancel out the effectiveness of one another. Many drug-herb interactions fall in this category.

Figure 1: Pharmacodynamic Interactions

altered hepatic (liver) metabolism

Some of the most complicated drug interactions and potentially serious drug-herb interactions for people with chronic hepatitis C are those involving altered liver metabolism. Much of the processing of medicinal substances in the liver is done by a group of enzymes called the cytochrome P-450 system. The activity of these liver enzymes that break down medicinal ingredients can be increased or decreased by drugs and herbs. When the activity of cytochrome P-450 enzymes is increased, drugs are broken down more quickly than expected. Circulating blood levels may be too low to bring about the desired effects. Conversely, when cytochrome P-450 activity is decreased, drugs may not be eliminated from the body as quickly as expected. Toxic levels of drugs may build up.

The effects of medicinal substances on liver metabolism are further complicated by the fact that a substance may increase the activity of some P-450 enzymes while decreasing the activity of others. The reactions of people with underlying liver disease such as chronic hepatitis C to substances metabolized by the liver are also somewhat unpredictable. A drug that is well tolerated by one person may cause serious problems in another person despite the fact that they appear to have similar stages of disease.

In summary, the potential for drug-herb interactions in people with liver disease is complex and often unpredictable. Substances with very different uses may well be processed by the same liver enzymes and interact in potentially serious, undesired ways. For example, you may not think there is any potential for interaction between an herb used to improve mood and a blood thinner since they have such different actions in the body. However, substances with these actions have been known to interact and cause very serious problems. (See the section on St. John's wort later in this chapter for additional information).

The potential for undesired and serious interactions is the reason you must keep all of your health care providers informed about all medicines, botanicals, and supplements you are taking. People with chronic hepatitis C should always be cautious about taking any medicinal substances. You should always check with a health care provider before taking anything new. Also keep in mind that many over-the-counter formulas marketed to people with hepatitis C contain several different herbs. Never take any medicinal product if you are uncertain about what it contains.

Keeping your providers informed about all of the prescription and over-the-counter substances you are taking is one of the most important responsibilities you have in your health care.

Now that you have been cautioned about taking and combining medicinal substances (including herbs), we can discuss some of the potential benefits of botanicals for people with chronic hepatitis C.

Silybum marianum (Milk Thistle)

Silybum marianum (milk thistle) has been used medicinally in Europe since the 13th century to treat liver-related diseases. It is available in Germany in both injectable and oral forms. ²⁶ A recent survey evaluated the use of complementary and alternative medicine (CAM) among hepatitis C patients in liver clinics. The survey found 42-73% of all patients who used other alternative therapies were also taking milk thistle. All participants who used only herbs to treat their liver disease (63%) identified milk thistle as one of the herbs taken.²⁷

The active ingredients in milk thistle are contained in the extract silymarin. Silymarin is a mixture of active plant materials that includes silybinin, a plant compound known as a flavinoid. Although silybinin has not been shown to have any antiviral activity against HCV, some flavinoids do have antiviral properties.

Silymarin has specific effects on liver cells that have been seen in laboratory animal studies. Silymarin appears to stabilize or strengthen liver cells’ ability to withstand the effects of substances that are toxic to the liver including recreational drugs, some medications, poisonous mushrooms, and chemicals. It prevents the damage that occurs when free radicals attack the fatty layer of liver cell membranes.²⁸ Silymarin also appears to inhibit the process of inflammation of liver cells that eventually leads to cirrhosis.²⁹ Silymarin increases glutathione levels in the liver. Some studies of hepatitis C patients have found abnormally low levels of glutathione.^30,31

There are no published studies on the effects of silymarin among large populations of people with hepatitis C, though there have been several studies on the effects of silymarin among people with liver disease. In people with acute hepatitis (both A and B), silymarin was found to decrease the number of complications, speed recovery time, and improve liver function test scores. ³² In chronic liver disease (both alcoholic and chronic hepatitis), silymarin has been shown to decrease symptoms of fatigue and abdominal pain, and to significantly decrease liver enzyme levels.³³ Silymarin has also been shown to improve the survival rates of people with cirrhosis. Those with histories of alcohol related liver damage fared better than those who had cirrhosis from drug use.³⁴ These studies were done prior to widespread testing for hepatitis C, so it is not known how many of the people in these studies were actually infected with HCV.

Not all studies with silymarin have shown a clear benefit in liver disease. A study of 125 patients with alcoholic cirrhosis who took 450 mg of silymarin per day for two years did not find any improvement associated with silymarin use.³⁵ Whether these results were influenced by the effects of alcohol abuse is not known.

A recent study on the effects of silymarin and liver damage in baboons found silymarin was effective in preventing fibrosis in alcohol-related liver damage.³⁶ The animals were given both alcohol and silymarin along with a nutritionally adequate diet for 3 years. The average dose of silymarin given to the baboons was the equivalent of 2,800 mg per day for a 150-pound person. This is significantly higher than the doses of silymarin used in previous human studies. The study found silymarin prevented fat accumulation in the liver and significantly decreased free-radical related damage to the liver, both of which can occur in people with chronic hepatitis C. This study does not mean it's safe to drink and take silymarin. Only two of the six baboons getting alcohol and silymarin escaped liver damage. The point of this study is that the positive effects from silymarin were achieved at a dosage much higher than what has been used in human studies with silymarin to date. This dosage level does not appear to be harmful in animals or humans, although, diarrhea may result from increased bile secretion.

Another form of silymarin called silipide or silybin-phosphatidylcholine has also been studied. This form is more easily absorbed than other forms of silymarin. In a small study with eight patients (five had hepatitis C), liver function tests and markers that reflect cell damage in the liver were significantly improved in patients who had been taking the equivalent of 120 mg of silybin twice daily between meals for two months.³⁷

Milk thistle is available over-the-counter in standardized extracts that contain 70% silymarin. The active ingredients of milk thistle are not water soluble. Therefore, a tea made from milk thistle seeds is not useful. If the label for milk thistle does not list the silymarin content, there is no guarantee there is any silymarin in it. Standard dosages used in studies range from 400-1,140 mg per day of the standardized extract. The common dosage for active liver disease is 200 mg of standardized extract (containing 70% silymarin) taken three times daily. Silipide (the phosphatidylcholine form) is commonly dosed at 100 mg taken three times daily.

Silymarin is safe and has no known toxicity, though doses over 1,500 mg per day may cause diarrhea because of increased bile secretion. Silymarin is safe to use in pregnancy and while breast feeding.³⁸ Silymarin has been shown to alter the activity of some P-450 enzymes. Although there have been no studies to determine if taking silymarin along with ribavirin and interferon alters the levels of these drugs in the body, that possibility does exist.

Glycyrrhiza glabra (Licorice Root)

Glycyrrhiza glabra (licorice root) preparations have been used in Japan for over 20 years to treat both hepatitis B and C.³⁹ Glycyrrhizin, an extract made from the Glycyrrhiza glabra plant, is used as an intravenous injection on a daily basis for eight weeks. The preparation can be given at that frequency or reduced to several times a week, and can be continued for as long as 16 years.

A study of 193 hepatitis C patients being treated with intravenous glycyrrhizin for 2-16 years showed decreased risk of developing cirrhosis. Those on treatment were about half as likely to develop cirrhosis compared to those not on the treatment (21% compared with 37%).³⁹ The rate of liver cancer was also less than half in those who were treated compared to those who were untreated. Twelve percent of the treated patients and 25% of the untreated patients developed liver cancer. German studies with intravenous glycyrrhizin showed that, when given daily, glycyrrhizin was as effective an antiviral agent as interferon, without the side effects. ⁴⁰

The intravenous form of glycyrrhizin is not readily available in the United States, but the oral form is easily available over-the-counter. The effectiveness of the oral formulation of glycyrrhizin against hepatitis B was studied in China. Significant numbers of patients who had taken 7.5 grams of licorice root (concentrated to 750 mg licorice root extract) twice daily for 30 days experienced a normalization of liver enzyme levels. Twenty-five percent of the patients fully recovered from hepatitis B, while no one in the control group recovered.⁴¹

Licorice root does have one potentially problematic side effect. A breakdown product of glycyrrizin alters the production of the hormone aldosterone. This can cause increased blood pressure, water retention, and a reduction in blood potassium. The injectable form of glycyrrhizin has two amino acids (glycine and cysteine) added to prevent this side effect, but pure licorice root does not. If you are taking doses higher than 400 mg of glycyrrhizin daily, have your blood pressure monitored regularly. If you have a history of high blood pressure and/or have kidney failure, you should avoid taking licorice root.

Other Botanical Medicines

Catechin is an extract of the Unicaria (cat’s claw) plant that has been researched extensively in England for its ability to improve liver function in people with hepatitis B.⁴²Although study results were positive, the research on catechin was discontinued in the late 1980’s because the use of the synthetic form of catechin resulted in a serious form of anemia in six patients.⁴³

Recently, research in Africa has identified plant compounds in the Garcinia species that have antiviral activity and are used by native people to treat hepatitis.⁴⁴ The active compound is a flavinoid (a vitamin-like compound found in many plants, fruits, and vegetables) and will continue to be the subject of research in treating both hepatitis B and C.⁴⁵

Other plant medicines used by native people in areas where hepatitis is common, such as those from the Phyllanthus amarus plant, have been shown to have direct antiviral effects on the hepatitis B virus.⁴⁶ Picrorhiza kurroa also has activity against hepatitis B, though neither of these plants have been tested specifically with hepatitis C.⁴⁷

Botanicals Used To Treat Extrahepatic Hepatitis C Problems

The serious effects of HCV on the liver are well known. We now know HCV also has serious effects on other parts of the body. The fatigue, depression, and lack of energy reported by hepatitis C patients (not on interferon-based therapy) may be related to an effect of HCV on the central nervous system.⁴⁸ In one study, researchers found problems with memory and concentration were not necessarily due to a history of intravenous drug use, depression, or fatigue, but were more closely related to HCV infection and some changes in brain function that were measured by a brain scan. This study brings to light what hepatitis C patients have long been describing as "brain fog." The changes seen in the brain scans were similar to changes seen in the brains of people with HIV infection. Although the way that HIV can damage the brain is still being studied, one of the mechanisms seems to involve the immune system found in the brain. When immune cells in the brain are stimulated by HIV infection, they produce free radicals that damage brain cells.⁴⁹ Treating the HIV-infected brain cells with vitamin E stopped damage and death in the affected brain cells.

Although we have little information about the effects of HCV on brain function, symptoms of forgetfulness and ‘brain fog’ are common complaints of people with hepatitis C. Research data showing that changes can be seen in the brain tissue of people with hepatitis C is evidence that HCV infection has an effect on brain tissue. Although we do not know if these changes occur in the same way as HIV-induced brain cell damage, we do know that free radical damage is a factor in many brain diseases such as Parkinson’s disease,⁵⁰ Alzheimer’s dementia,⁵¹ and many others. While it is reasonable for a person with HCV to take antioxidants for liver health, there are antioxidants that have been tested specifically for treating damage to brain cells and the symptoms of memory loss and lack of attention that result.

Gingko biloba

Gingko biloba extract has been shown to protect brain cells from damage due to aging and oxidative stress. It has been the subject of over 400 published studies in the last 30 years. In human trials, Gingko biloba extract has been shown to be effective at improving blood supply to the brain. It also has a beneficial effect on attention span and brain function in elderly patients, resulting in significant improvements in memory, alertness, and mood.⁵² Studies in those with Alzheimer’s dementia have shown beneficial effects on alertness, concentration, and memory.⁵³ When Gingko biloba extract was compared to four medications called cholinesterase-inhibitors that are used to treat mild to moderate dementia from Alzheimer’s disease, gingko was as effective as all four drugs with very few side effects. ⁵⁴

Depression is another common symptom of hepatitis C, even among people who are not being treated with western drug therapy (see Chapter 4, Signs and Symptoms That May Be Associated with Hepatitis C). In one study, 28% of people being seen in a clinic for hepatitis C were diagnosed with depression.⁵⁵ Gingko biloba was used in a study about depression in older adults who had not responded to standard antidepressants.⁵⁶ The group that stayed on their antidepressant medication experienced little improvement in their depression, however the group that took antidepressant medication plus gingko experienced significant improvements. Gingko is an approved prescription drug in Europe, and has been proven safe and nontoxic.⁵⁷ All the published studies with gingko used an extract that contains 24% gingko heterosides. The extract was given in doses of 40-80 mg three times daily. A few case reports have been published in the medical literature of people who were diagnosed with bleeding in the brain who were also using high amounts (up to 1200 mg per day) of gingko. It is not clear if the gingko was related to the bleeding. There are no contraindications (situations in which it should not be used) to ginko use stated by the German Commission E (a group that studies the uses and safety of herbs and nutritional supplements) if it is taken in prescribed doses of 120-240 mg per day.

Hypericum perfoatum (St. John’s Wort)

St. John’s Wort (Hypericum perfoatum) is a plant product that has been studied for its antidepressant action. A review of 27 human studies indicated St. John’s Wort is effective for mild-to-moderate depression. The St. John’s Wort in these studies was given as a 0.2% hypericin-based preparation (one of the active ingredients).⁵⁸ The studies examined St. John’s Wort alone and in comparison to the popular antidepressants fluoxetine (Prozac^®) and imipramine (Tofranil^®). The studies clearly demonstrated St. John’s Wort was equally effective with significantly fewer side effects than the standard antidepressants. However, it was also clear that St. John’s Wort is not effective for severe depression. Prescription drugs work better for severe depression.

A very small number of harmful side effects have been reported from use of St. John’s Wort. Over eight million people were given prescriptions for St. John’s Wort in Germany over the past decade. In this time period, only 70 people complained of negative side effects which included allergic reactions, stomach complaints, rashes after sunlight exposure, breakthrough bleeding on birth control pills, prolonged prothrombin (clotting) time, and interactions with the drug cyclosporin (given to transplant recipients).⁵⁹ St. John’s Wort has been shown to affect the speed at which the liver breaks down certain drugs. It may lower levels of certain drugs in the bloodstream. Following is a list of drugs that are known to interact with St. John’s Wort. If you are taking any of these drugs, you should consult your health care provider before taking St. John’s Wort.

Drugs That Interact with St. John’s Wort

prescription antidepressants
oral contraceptives
anticoagulants (Coumadin)
theophylline
indinavir
digoxin
cyclosporin

Reasons for Using Naturopathic Medicine and Who May Benefit

Naturopathic treatment options may benefit those who are motivated to adopt the following healthy lifestyle practices.

following a nutritious diet that is low in sugar, red meat, and processed foods
not smoking
avoiding alcohol and recreational drugs
exercising often
managing daily stress

While these practices will be helpful with any therapeutic approach, they are vital to the success of naturopathic treatment. If you choose a naturopathic approach, you need to be willing to take nutritional supplements and botanicals suggested in this chapter and in the chapter on nutritional supplementation (Chapter 16, Nutritional Supplementation), or those prescribed by your naturopathic doctor. You must also be willing to eat a healthy diet (see Chapter 7, Nutrition and Hepatitis C). If cost is a concern, you need to be aware that most health insurance policies do not cover nutritional supplements and botanicals.

Anecdotal Story of a Person for Whom the Naturopathic Approach was Appropriate

Helen had been diagnosed with hepatitis C after a slight elevation of her liver enzymes led to testing six years prior to coming to our office. She had no idea how she had been infected, and had not experienced any symptoms that she knew were related to hepatitis C. Although her viral load was in the low range (300,000 copies) and her liver biopsy showed only mild inflammation, her gastroenterologist encouraged her to start interferon-based treatment. Helen was resistant because she was a single mother of three children, had a demanding job, and was supporting an ailing mother. She was afraid the side effects of treatment would make it hard for her to keep up with her responsibilities. She worried about being able to care for her children and provide financial support for her mother. She did not have a strong support system of friends and family who could step in and take care of her children if treatment made her tired and depressed.

Helen was willing to change her diet and she had given up alcohol when she was first diagnosed. She was also willing to find time to exercise with her children several times per week. She agreed to take the antioxidant protocol and botanicals faithfully. Her gastroenterologist agreed to follow her liver enzymes for six months and repeat the liver biopsy to see if any improvement had occurred. Helen was relieved that she could do something other than watch and wait, and that the treatment approach she was taking fit into her belief system.

Reasons for Not Using Naturopathic Medicine

The appropriate treatment for people with end-stage liver failure is western medical care including possible liver transplantation. Alternative medicine, including naturopathic medicine, cannot effectively treat end-stage liver failure.

If you are unwilling or unable to make the necessary lifestyle changes, you probably will not benefit from a naturopathic approach. From the naturopathic perspective, it is difficult for the liver to heal when it is under siege from cigarette smoke, alcohol, recreational drugs, and/or the chemicals found in processed foods. For naturopathic treatment to work, you need to be willing to "clear the way" before you can expect any changes from of a naturopathic treatment protocol.

Anecdotal Story of a Person for Whom the Naturopathic Approach Alone was Not Appropriate

Robert is a 43-year-old lawyer who contracted hepatitis C during a brief period of intravenous drug use when he was in his twenties. He was diagnosed when a yearly physical showed his liver enzymes were elevated 10-15 times above the normal level. His viral load was also high (over 30 million) and his liver biopsy revealed cirrhosis. Robert had not experienced symptoms other than some intestinal bloating and a little fatigue after work. He blamed these symptoms on his heavy work schedule, eating on the run, and the stress of his demanding job. Robert was interested in treating his hepatitis C, but wanted to use an alternative approach. He wanted to take an herbal pill that would "get rid of the virus once and for all without the side effects that the drugs have." He wanted to continue working full time. He also drank alcohol often, usually after work to wind down, and smoked a pack of cigarettes per day. He was quite willing to take supplements and antioxidants, but when it came to lifestyle changes, Robert was not so sure. He did not want to make any drastic changes, though he was willing to cut down on his alcohol and nicotine use and “maybe start eating a little better.” However, he was not willing to give up anything altogether. He was aware that he was not dealing with stress very well. He had high blood pressure and daily tension headaches. He did not have time to exercise or do anything that would take him away from his work. Robert was also seeing a gastroenterologist who had warned him that his condition was serious and he needed treatment, but Robert wanted an “easier” route to recovery.

It was suggested to Robert that he pursue western antiviral therapy in addition to a naturopathic approach for several reasons. It was crucial that Robert quit drinking and his naturopathic doctor knew that. She also knew that Robert would not be able to get western treatment if he continued to drink. She hoped that with the support of Robert’s gastroenterologist, they could convince Robert to stop using alcohol and begin treatment. Robert’s situation was dangerous. He had a high viral load, significantly elevated liver enzymes, and cirrhosis. He was at risk for advanced hepatitis C including the possibilities of liver transplant and/or liver cancer. With a combined treatment approach, he could have a positive response to treatment. This would stabilizes his liver and prevent the complications of advanced cirrhosis. Robert did not want to make the lifestyle changes that his naturopath suggested: working less, making drastic changes in his diet, getting exercise, using stress management tools, and giving up nicotine and alcohol. The naturopathic approach requires lifestyle changes in addition to taking supplements and botanical medicines. Robert really did not have a lot of time to waste, so a combined approach was probably the best approach for him. This would allow him to use supplements and some botanicals to help his liver while undergoing western treatment for the hepatitis C.

Summary

Naturopathic medicine offers people infected with HCV another tool in their efforts to treat their disease. Many people infected with HCV who include naturopathic medicine in their treatment protocol use it primarily as a way to enhance the body’s ability to heal itself. Many feel that by doing this, they can keep the virus under control until more is known about it and/or better treatment options are available. Other people infected with HCV use naturopathic medicine as their primary care option. If and how naturopathic care fits into your treatment protocol is up to you.

If naturopathic care is something you are interested in, it is important that you find out as much as you can about it. There are many books and Internet sites that can help you better understand what naturopathic medicine has to offer. Some of these resources are listed in the Resource Directory.