Hepatitis C: A Focus on Herbal Supplements

On this page:

• Introduction
• Key Points
• About Hepatitis C
• Use of Herbal Supplements for Hepatitis C
• What the Science Says
• If You Have Hepatitis C and Are Thinking About Using an Herbal Supplement
• For More Information

Introduction

Hepatitis C, a liver disease caused by a virus, is usually chronic (long-lasting), with symptoms ranging from mild (or even none) to severe. Conventional medical treatments are available for hepatitis C; however, some people also try complementary health practices, especially herbal supplements. This fact sheet provides basic information on hepatitis C, summarizes scientific research on the effectiveness and safety of selected supplements, and suggests sources for additional information.

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Key Points

• No complementary health practice has been proven effective for treating hepatitis C or its complications.

• It is important not to replace conventional medical therapy for hepatitis C with an unproven complementary health practice.

• Tell your health care providers about any complementary health practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

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About Hepatitis C

People who are newly infected have what is called acute hepatitis C. Most people with acute hepatitis C develop chronic hepatitis C, which can injure the liver over time. Many people with hepatitis C show no symptoms for many years; others experience mild or more serious symptoms.

People with more serious or chronic hepatitis C may need medication—interferon, alone or combined with ribavirin. However, not everyone with hepatitis C responds to drug therapy, and the drugs have side effects that can be difficult to tolerate. To learn more, visit the National Institute of Diabetes and Digestive and Kidney Diseases Web site.

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Use of Herbal Supplements for Hepatitis C

A number of herbal products claim to be beneficial for the liver. Because many patients with hepatitis C do not respond to standard antiviral treatment, or are unable to undergo full treatment, they may explore these products. For example, a survey of 1,145 participants in the HALT-C (Hepatitis C Antiviral Long-Term Treatment Against Cirrhosis) trial, a study supported by the National Institutes of Health (NIH), found that 23 percent were using herbal products at the time of enrollment. Although participants reported using many different herbal products, silymarin (milk thistle) was by far the most common.

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What the Science Says

A review of the scientific evidence on CAM and hepatitis C found the following:

• No complementary health practice has been scientifically proven to successfully treat hepatitis C.

• A 2003 analysis of results from 13 clinical trials testing the effects of various medicinal herbs on hepatitis C concluded that there is not enough evidence to support using herbs to treat the disease.

• Two other reviews that covered a variety of CAM modalities for hepatitis C concluded that conventional therapies are the only scientifically proven treatments for the disease.
• In a 2002 NIH consensus statement on the management of hepatitis C, a panel of medical and scientific experts concluded that “alternative and nontraditional medicines” should be studied. Participants in a 2001 NIH research workshop on the benefits and risks of CAM therapies for chronic liver disease recommended research support for related laboratory and clinical studies.

The following section summarizes what is known about the safety and effectiveness of milk thistle and some of the other complementary health products that people with hepatitis C use.

Milk thistle (scientific name Silybum marianum) is a plant from the aster family. Silymarin, the active extract of milk thistle, is believed to be responsible for the herb’s medicinal qualities. Milk thistle has been used in Europe as a treatment for liver disease and jaundice since the 16th century. In the United States, silymarin is the most popular complementary health product taken by people with liver disease.

Laboratory studies suggest that milk thistle may benefit the liver by protecting and promoting the growth of liver cells, fighting oxidation (a chemical process that can damage cells), and inhibiting inflammation. Study results from small clinical trials on milk thistle for liver diseases have been mixed; however, most of these studies were not rigorously designed, or they looked at various types of liver diseases—not just hepatitis C.

High-quality, well-designed clinical trials have not proven that milk thistle or silymarin is beneficial for treating hepatitis C.

• A 2012 controlled clinical trial, cofunded by the National Center for Complementary and Alternative Medicine (NCCAM) and the National Institute of Diabetes and Digestive and Kidney Diseases, showed that two higher-than-usual doses of silymarin were no better than placebo in reducing the high blood levels of an enzyme that indicate liver damage. In the study, 154 people who had not responded to standard antiviral treatment for chronic hepatitis C were randomly assigned to receive 420 mg of silymarin, 700 mg of silymarin, or placebo three times per day for 24 weeks. At the end of the treatment period blood levels of the enzyme were similar in all three groups.
• The HALT-C study mentioned above found that silymarin use by people with hepatitis C was associated with fewer and milder symptoms of liver disease and somewhat better quality of life, but there was no change in virus activity or liver inflammation. The researchers emphasized that this was a retrospective study, not a controlled clinical trial.

Milk thistle is generally well tolerated and has shown few side effects in clinical trials involving patients with liver disease. It may cause a laxative effect, nausea, diarrhea, abdominal bloating, fullness, and pain, and it can produce allergic reactions (especially among people who are allergic to plants in the same family, such as ragweed, chrysanthemum, marigold, and daisy).

Other supplements are also being studied for hepatitis C. For example:

• Ginseng has shown some beneficial effects on the liver in laboratory studies but has not yet shown effects in people.

• Thymus extract and colloidal silver are sometimes marketed for the treatment of hepatitis C, but there is currently no research to support their use for this purpose. Colloidal silver can cause serious side effects (for more information, see the NCCAM fact sheet Colloidal Silver).

• People with chronic liver disease sometimes use licorice root or its extract glycyrrhizin. Some studies, reported from outside the United States, have looked at glycyrrhizin administered intravenously for hepatitis C. Preliminary evidence from these studies suggests that glycyrrhizin may have beneficial effects against hepatitis C. However, additional research is needed before reaching any conclusions.
• Preliminary studies conducted primarily outside the United States have examined the potential of the following herbal products for treating chronic hepatitis C: lactoferrin, TJ-108 (a mixture of herbs used in Japanese Kampo medicine), schisandra, and oxymatrine (an extract from the sophora root). More research is needed before the safety and effectiveness of these products can be fully evaluated.

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If You Have Hepatitis C and Are Thinking About Using an Herbal Supplement

• Do not replace proven conventional treatments for hepatitis C with complementary health practices that are unproven.

• Be aware that some herbal products may damage the liver. For example, the herbs kava and comfrey have been linked to serious liver damage.

• Also be aware that the label on a supplement bottle may not accurately reflect what is inside. For example, some tests of dietary supplements have found that the contents did not match the dosage on the label, and some herbal supplements have been found to be contaminated.

• If you are pregnant or nursing a child, or if you are considering giving a child a dietary supplement, it is especially important to consult your health care provider. Supplements can act like drugs, and many have not been tested in pregnant women, nursing mothers, or children.
• Tell your health care providers about any complementary health practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care. For tips about talking with your health care providers about complementary health practices, see NCCAM's Time to Talk campaign.

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