-IBIS-1.7.6-
tx
digestive system
hepatitis
Nutrition

dietary guidelines

eating principles:
• Diet should be concentrated with fruits and vegetables because of their flavonoid compounds which will benefit the liver. Especially useful are soups with various green leafy vegetables.
Avoiding alcohol, caffeine, coffee, black tea, cola and chocolate, and sugar are important to decrease the stress load on the liver.
• High protein, lacto-ovo vegetarian diet
• High fiber diet

therapeutic foods:
Dandelion greens, burdock root, mustard greens, black radish, apples and saffron, watercress, beets, parsley, artichokes, cherries, grapefruit, parsnips, endive, garlic, onion, chicory, carob, horseradish, kumquats, limes, quinces, grapes, lemon juice mixed with water, upon rising in the morning 30 minutes before eating (Shefi)
• Wheat germ, lecithin, yogurt, tofu, soy
Ganoderma mushrooms (Chao-liang, Qing-rong, Bao-zhen, p. 114)
Green tea: two to three cups per day.

fresh juices:
• Radish and pineapple (Jensen, p. 52)
• Black cherry concentrate mixed with liquid chlorophyll (Jensen, p. 52)
• • Carrot, beet, and cucumber (Jensen, p. 52)
Cucumber, radish, green pepper
• Papaya
• Cherry
• Carrot (Walker, p. 145)
• Carrot and spinach (Walker, p. 145)

specific remedies:
• Eat 3-4 oz. fresh white mushrooms three times daily. (Butt and Bloomfield, p. 136)
• Take 4 oz. fresh grapes and boil in l pt. water until reduced by half, drink and eat (Butt and Bloomfield, p. 136)

avoid:
• saturated fats, meat, alcohol, hot sauces, spicy foods, fried foods, fatty foods, rich foods, salty foods, cow's milk and other dairy products, white bread, refined foods, processed foods, sugar and sweets, catarrh-forming foods: tofu, meat, ice cream, shellfish, coffee, caffeine
• trans-fatty acids, hydrogenated oils (margarine, vegetable shortenings, imitation butter spreads, most commercial peanut butters) oxidized fats (deep fried foods, fast food, ghee, barbequed meats)
• refined, simple carbohydrates: sucrose, white flour, processed foods


supplements
High potency multivitamin and mineral supplement without iron. The fat soluble vitamins are the most critical, especially if cirrhosis present (50% of patients have fat malabsorption). Vitamin K 5mg IM injection daily for 3 days is often given to rule out hypothrombinemia. (Marz, 1997, 374.)
Vitamin B12 IM injections, or 1,000 mcg orally, on a daily basis, has a strong history of anecdotal use but research has not shown consistent positive outcomes (Jain, 1960; Campbell RE, Pruitt FW. Am J Med Sci 1952;224:252-262.)
Vitamin B12 and folic acid (Campbell RE, Pruitt FW. Am J Med Sci 1955;229:8.)
Vitamin C 40-100 g per day. (Cathcart, 1981)
Vitamin C (buffered): 2 grams, three times daily, or more if can tolerate bowel-wise; research with 2 g per day has produced mixed results. (Baur H, Staub H. JAMA 1954;156:565; Morishige F, Murata A. J Int Acad Prev Med 1978;5:54; Knodell RG, et al. Am J Clin Nutr 1981;34:20-23; Marz, 1997, 374.)
Vitamin E tends to be low in individuals with hepatitis. While a study using 300 IU per day for children with viral hepatitis failed to show any significant benefit, other research involving adults found that 1,200 IU per day could reduce liver damage.
(Mezes M, et al. Int J Clin Pharmacol Res 1986;6:333–338; Pan WH, et al. Ann Epidemiol 1993;3:217-224; Von Herbay A, et al. Free Radic Res 1996;25:461-466; Yurdakok M, Kanra G. Mikrobiyol Bul 1986;20:91-94; Houglum K, et al. Gastroenterology 1997;113:1069-1073; von Herbay A, et al. Free Radic Res. 1997 Dec;27(6):599-605.)
IV or IM weekly treatments of antiviral IV multivitamin and minerals (Alan Gaby). Dr. Robert Cathcart has used very high levels of IV vitamin C 40-100 mg per day in the treatment of hepatitis and has had great success. (Marz, 1997, 374.)
Multi-antioxidant combination formulas: antiviral, free radical quenching and immune boosting qualities. In a smal study o fthree patients Berkson found that the combination of alpha lipoic acid (thioctic acid), silymarin, and selenium "protect the liver from free radical damage, increase the levels of other fundamental antioxidants, and interfere with viral proliferation."
(Berkson BM. Med Klin. 1999 Oct 15;94 Suppl 3:84-89.)
Alpha-Lipoic acid: 150 mg, two to three times per day; potent antioxidant activity (Loginov AS, et al. Farmakol Toksikol. 1989 Jul-Aug;52(4):78-82; Loginov AS, et al. Farmakol Toksikol. 1990 Mar-Apr;53(2):47-50; Nichols TW Jr. Alt Med Rev 1997;2:177-183; Berkson BM. Med Klin. 1999 Oct 15;94 Suppl 3:84-89.)
L-carnitine One g of carnitine taken three times daily may be helpful according to some preliminary research. Carnitine is essential for mitochondrial energy production. (Kuratsune H, et al. Int J Mol Med. 1998 Jul;2(1):51-56.)
Catechin: 500-750 mg, three times dail,y has produced mixed results in research
(Bar-Meir S, et al. Gut 1985;26:975-979; Suzuki H, et al. Liver 1986;6:35-44.)
DHEA: if levels are low, in chronic hepatitis (Marz, 1997, 374.)
Liver extract: protomorphogen therapy, can be given IM or orally
N-acetyl cysteine 500 mg twice daily. (Marz, 1997, 374.)
Phosphatidyl choline (as in lecithin): 3 grams per day for individuals with chronic hepatitis B ( Jenkins PJ, et al. Liver 1982;2:77-81.)
Taurine: 4 gms, three times daily. (acute hepatitis)
Thymus extract: 40 mg of purified proteins, three times per day, or 200 mg of crude extracts, three times per day. A variety of studies infdicate benefit for individuals with hepatitis C. (Bortolotti F, et al. Curr Ther Res 1988;43:67-72; Civeira MP, et al. Aliment Pharmacol Ther 1989 Aug;3(4):395-401; Zeman K, et al. Immunol Invest. 1991 Dec;20(7):545-555.)
Tumeric or Curcumin: Research involving rats has shown hepatoprotective effects against inflammatory conditions of the liver found in toxic exposure to carbontetrachloride and glucosamine. It tends to prevent liver enzymes from reaching excessive levels. It also increases the flow and solubility of bile, so that it may protect against gall bladder stone formation.
(Deshpande UR, et al. Indian J Exp Biol. 1998 Jun;36(6):573-577.)


footnotes

Bar-Meir S, Halpern Z, Gutman M, Shpirer Z, Baratz M, Bass D. Effect of (+)-cyanidanol-3 on chronic active hepatitis: A double blind controlled trial. Gut 1985;26:975-979.

Baur H, Staub H. Treatment of hepatitis with infusions of ascorbic acid: Comparison with other therapies. JAMA 1954;156:565. (Abstract)

Berkson BM. A conservative triple antioxidant approach to the treatment of hepatitis C. Combination of alpha lipoic acid (thioctic acid), silymarin, and selenium: three case histories. Med Klin. 1999 Oct 15;94 Suppl 3:84-89.
Abstract: BACKGROUND: There has been an increase in the number of adults seeking liver transplantation for hepatitis C in the last few years and the count is going up rapidly. There is no reliable and effective therapy for chronic hepatitis C since interferon and antivirals work no more than 30% of the time, and liver transplant surgery is uncertain and tentative over the long run. This is because, ultimately, residual hepatitis C viremia infects the new liver. Furthermore, liver transplantation can be painful, disabling and extremely costly. TREATMENT PROGRAM: The author describes a low cost and efficacious treatment program in 3 patients with cirrhosis, portal hypertension and esophageal varices secondary to chronic hepatitis C infection. This effective and conservative regimen combines 3 potent antioxidants (alpha-lipoic acid [thioctic acid], silymarin, and selenium) that possess antiviral, free radical quenching and immune boosting qualities. CONCLUSION: There are no remarkably effective treatments for chronic hepatitis C in general use. Interferon and antivirals have less than a 30% response rate and because of the residual viremia, a newly transplanted liver usually becomes infected again. The triple antioxidant combinaton of alpha-lipoic acid, silymarin and selenium was chosen for a conservative treatment of hepatitis C because these substances protect the liver from free radical damage, increase the levels of other fundamental antioxidants, and interfere with viral proliferation. The 3 patients presented in this paper followed the triple antioxidant program and recovered quickly and their laboratory values remarkably improved. Furthermore, liver transplantation was avoided and the patients are back at work, carrying out their normal activities, and feeling healthy. The author offers a more conservative approach to the treatment of hepatitis C, that is exceedingly less expensive. One year of the triple antioxidant therapy described in this paper costs less than $2,000, as compared to more than $300,000 a year for liver transplant surgery. It appears reasonable, that prior to liver transplant surgery evaluation, or during the transplant evaluation process, the conservative triple antioxidant treatment approach should be considered. If these is a significant betterment in the patient's condition, liver transplant surgery may be avoided.

Blank RD. Oral thymic extract to treat hepatitis C. Ann Intern Med. 1999 Aug 17;131(4):312.

Bortolotti F, et al. Effect of an orally administered thymic derivative, thymomodulin, in chronic type B hepatitis in children. Curr Ther Res 1988;43:67-72.

Campbell RE, Pruitt FW. The effect of vitamin B12 and folic acid in the treatment of viral hepatitis. Am J Med Sci 1955;229:8.

Campbell RE, Pruitt FW. Vitamin B12 in the treatment of viral hepatitis. Am J Med Sci 1952;224:252-262.

Civeira MP, Castilla A, Morte S, Serrano M, Prieto J. A pilot study of thymus extract in chronic non-A, non-B hepatitis. Aliment Pharmacol Ther 1989 Aug;3(4):395-401.
Abstract: In previous studies it has been suggested that activation of cellular immunity may have a role in controlling the activity of chronic non-A, non-B liver disease. We conducted a pilot study of therapy with a bovine thymus extract for 6 weeks in 15 consecutive patients with chronic non-A, non-B hepatitis, most of them sporadic cases. Treatment induced immunomodulation, and in five patients a significant but transient diminution in aminotransferase levels was observed associated with increments in several parameters of cellular immunity. This suggests that a longer administration of this or other related compounds, or treatment with a more potent immunomodulating agent, might be effective in these patients.

Deshpande UR, Gadre SG, Raste AS, Pillai D, Bhide SV, Samuel AM. Protective effect of turmeric (Curcuma longa L.) extract on carbon tetrachloride-induced liver damage in rats. Indian J Exp Biol. 1998 Jun;36(6):573-577.
Abstract: The protective effect of tumeric extract (TE) in diet on CCl4-treated rats was studied. Rats were divided into 5 groups: (1) untreated, (2) CCl4 treated, (3) pre-TE for 2 weeks followed by CCl4, (4) TE + CCl4 given concurrently and (5) 5% TE as positive control. The serum levels of bilirubin, cholesterol, aspartate aminotransferase, (AST), alanine amino transferase (AST), (ALT) and alkaline phosphatase were estimated after 1, 2 and 3 months. CCl4 caused a maximum increase (2-3-fold in all the above parameters. As compared to CCl4 group, a short pre-treatment of TE showed reduction in cholesterol, bilirubin, AST, ALT and alkaline phosphatase activity whereas concurrent treatment of TE + CCl4 reduced to a greater extent the levels of all parameters except ALT. To conclude, concurrent treatment of TE gave significant protection against CCl4 though the values did not reach the normal levels.

Frossard JL. Oral thymic extract to treat hepatitis C. Ann Intern Med. 1999 Aug 17;131(4):312.

Galli M, Crocchiolo P, Negri C, Caredda F, Lazzarin A, Moroni M. Attempt to treat acute type B hepatitis with an orally administered thymic extract (thymomodulin): Preliminary results. Drugs Exp Clin Res 1985;11(9):665-669.
Abstract: A double-blind trial with thymomodulin (TM) was performed in a consecutive series of 50 inpatients affected with acute type B hepatitis. Twenty-six randomly selected patients received TM (Leucotrofina, Ellem), 1 ampoule twice daily per os for 30 days, and 24 patients received the same amount of placebo for the same period. TM-treated patients showed accelerated AST and ALT decrease and an earlier HBsAg clearance. However, only the difference in ALT decrease was statistically significant in comparison with the controls (p less than 0.02). Before the treatment was started, lymphocyte subsets, as determined by monoclonal antibodies, showed a different pattern in the two groups despite strict randomization. Nevertheless, by the end of the trial, mean T4+/T8+ ratios were increased in the treated group, but remained unchanged in the control group. The trends in the two groups were significantly different (p less than 0.005). Further information is expected from a long-term follow-up.

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 Oct;113(4):1069-1073.
Abstract: BACKGROUND & AIMS: Oxidative stress mediates activation and stimulates collagen production of cultured hepatic stellate (Ito) cells. The aim of this study was to assess whether oxidative stress contributes to hepatic fibrogenesis in chronic hepatitis C. METHODS: In liver biopsy specimens of patients with chronic hepatitis C, the following fibrogenesis cascade was analyzed: (1) oxidative stress, determined by the presence of malondialdehyde protein adducts; (2) activation of stellate cells as indicated by their expression of alpha-smooth muscle actin; (3) stimulation of c-myb expression in stellate cells, a critical step in the activation of these cells; and (4) induction of collagen gene expression as detected by in situ hybridization. RESULTS: Treatment with d-alpha-tocopherol (1200 IU/day for 8 weeks) in 6 of these patients, who were refractory to interferon therapy, prevented the fibrogenesis cascade observed before antioxidant treatment. In addition, d-alpha-tocopherol treatment significantly decreased the carbonyl modifications of plasma proteins, a sensitive index of oxidative stress. However, 8 weeks of d-alpha-tocopherol treatment did not significantly affect serum alanine aminotransferase levels, hepatitis C virus titers, or histological degree of hepatocellular inflammation or fibrosis. CONCLUSIONS: These data suggest that enhanced oxidative stress initiates a fibrogenesis cascade in the liver of patients with chronic hepatitis C.

Jenkins PJ, Portmann BP, Eddleston AL, Williams R. Use of polyunsaturated phosphatidyl choline in HBsAg negative chronic active hepatitis: Results of prospective double-blind controlled trial. Liver 1982 Jun;2(2):77-81.
Abstract: In a prospective double-blind trial, polyunsaturated phosphatidyl choline therapy (3 g/day) was given in addition to normal maintenance immunosuppressive therapy to 15 patients with HBsAg negative chronic active hepatitis. Histological evidence of disease activity was significantly reduced in the phospholipid-treated group. The results indicate that polyunsaturated phosphatidyl choline is of value as additional treatment in the management of patients with HBsAg negative chronic active hepatitis whose disease is inadequately controlled with conventional doses of immunosuppressive therapy.

Knodell RG, Tate MA, Akl BF, Wilson JW. Vitamin C prophylaxis for posttransfusion hepatitis: lack of effect in a controlled trial. Am J Clin Nutr 1981;34:20-23.

Kuratsune H, Yamaguti K, Lindh G, Evengard B, Takahashi M, Machii T, Matsumura K, Takaishi J, Kawata S, Langstrom B, Kanakura Y, Kitani T, Watanabe Y. Low levels of serum acylcarnitine in chronic fatigue syndrome and chronic hepatitis type C, but not seen in other diseases. Int J Mol Med. 1998 Jul;2(1):51-56.
Abstract: Recently, we found a serum acylcarnitine (ACR) deficiency in Japanese patients with chronic fatigue syndrome (CFS). To clarify whether this ACR abnormality is a characteristic of CFS or not, we also studied the levels of serum carnitine in Swedish subjects. Both serum ACR and free carnitine (FCR) levels in normal healthy subjects were quite different between Japanese (n=131) and Swedish people (n=46) (p<0.001). However, it is confirmed that Swedish patients with CFS (n=57) also had serum ACR deficiency (p<0.001). When we studied the levels of serum ACR and FCR in Japanese patients with various kinds of diseases (CFS, hematological malignancies, chronic pancreatitis, hypertension, diabetes mellitus, chronic hepatitis type C, psychiatric diseases), a significant decrease in the levels of serum ACR was only found in patients with CFS and chronic hepatitis type C (p<0.001). Therefore, we concluded that ACR deficiency in serum might be a characteristic abnormality in only certain types of diseases.

Loginov AS, Nilova TV, Bendikov EA, Petrakov AV. [Pharmacokinetics of preparations of lipoic acid and their effect on ATP synthesis, processes of microsomal and cytosol oxidation in hepatocytes in liver damage in man].
Farmakol Toksikol. 1989 Jul-Aug;52(4):78-82. [Article in Russian]

Loginov AS, Nilova TV, Bendikov EA, Petrakov AV. [Preparations of alpha-lipoic acid: the dynamics of their content in the blood and their effect on hemostasis in lesions of the human liver]. Farmakol Toksikol. 1990 Mar-Apr;53(2):47-50. [Article in Russian]

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(4):333-338.
Abstract: As free radicals and lipid peroxidation are involved in the pathogenesis of different inflammatory diseases of the liver, the blood malondialdehyde content, the activity or quantity of free radical eliminating enzymes and the natural antioxidant, vitamin E serum level has been studied in ten patients with chronic active hepatitis and in six subjects with alcoholic liver disease. Thirty healthy volunteers served as controls. The serum malondialdehyde/thiobarbituric acid reactive substance and its concentrations increased significantly in both hepatitis groups. The superoxide dismutase content was also raised in the patients' sera. The serum glutathione peroxidase (GSH-Px) activity was decreased in both groups, while the red blood cell GSH-Px showed a significantly lower activity in the alcoholic hepatitis patients. Serum catalase activity and vitamin E levels in both types of chronic hepatitis were not significantly different from the healthy controls.

Morishige F, Murata A. Vitamin C for prophylaxis of viral hepatitis B in transfused patients. J Int Acad Prev Med. 1978;5:54.

Nichols TW Jr. Alpha-lipoic acid: biological effects and clinical implications. Alt Med Rev 1997;2:177–183. (Review)

Packer L, Witt EH, Tritschler HJ. Alpha-lipoic acid as a biological antioxidant. Free Rad Biol Med 1995;19:227-250. (Review)

Pan WH, Wang CY, Huang SM, Yeh SY, Lin WG, Lin DI, Liaw YF. Vitamin A, Vitamin E or beta-carotene status and hepatitis B-related hepatocellular carcinoma. Ann Epidemiol 1993 May;3(3):217-224.
Abstract: A case-control study was carried out in 59 patients with newly diagnosed hepatocellular carcinoma and 101 control subjects, who were all male hepatitis B carriers. The odds ratios of hepatocellular carcinoma occurring among hepatitis B carriers in the lowest quartile and those highest quartile of dietary and serum status were 5.3 (1.9 to 15.0) and 86.9 (20.0 to 377.2), respectively. The odds ratios for hepatitis B carriers in the lowest quartile and those in the highest quartile of dietary and serum beta-carotene status were 1.7 (0.7 to 4.1) and 5.0 (1.9 to 13.2). Vitamin E status did not differ in case patients and control subjects. Low education level, heavy consumption of alcohol, and smoking status were also associated with increased odds of hepatocellular carcinoma. Serum retinol, positively associated with dietary retinol, demonstrated an independent effect on hepatocellular carcinoma. This effect may reflect changes in the physiologic condition of the patients at the time of entering the hospital.

Raymond RS, Fallon MB, Abrams GA. Oral thymic extract for chronic hepatitis C in patients previously treated with interferon. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 1998 Nov 15;129(10):797-800.
Abstract: BACKGROUND: Hepatitis C is an important cause of chronic liver disease. It is claimed that Complete Thymic Formula, an over-the-counter herbal dietary supplement, is beneficial for patients with hepatitis C. OBJECTIVE: To evaluate the efficacy and safety of Complete Thymic Formula. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Tertiary referral center. PATIENTS: 38 patients with hepatitis C who did not respond to or were intolerant of interferon therapy. INTERVENTION: Complete Thymic Formula for 3 to 6 months or placebo for 3 months. MEASUREMENTS: Serial measurements of hepatitis C virus (HCV) RNA titers. RESULTS: No differences were noted at 3 months between the placebo group (n = 13) and the treatment group (n = 19) in mean HCV RNA titers (4.06 +/- 1.52 x 10(6) copies/mL compared with 3.48 +/- 1.92 x 10(6) copies/mL; P > 0.2). The 19 patients who completed 6 months of treatment with Complete Thymic Formula remained positive for HCV, and their mean HCV RNA titers were similar at 6 months and at baseline (2.78 +/- 1.96 x 10(6) copies/mL compared with 3.12 +/- 1.94 x 10(6) copies/mL; P > 0.2). CONCLUSIONS: Complete Thymic Formula did not benefit patients who had previously received interferon therapy. Patients should be advised about use of this over-the-counter compound.

Skotnicki AB, Wolny-Niedzielska A. [Immunologic aspects of acute and chronic hepatitis -- perspectives of immunotherapy]. Przegl Lek. 1979;36(4):393-398. [Article in Polish]

Skotnicki AB. Therapeutic application of calf thymus extract (TFX). Med Oncol Tumor Pharmacother 1989;6:31-43. (Review)
Abstract: The semipurified calf thymus extract, TFX, produced since 1973 by the Polish Pharmaceutical Industry (POLFA) has been found to exert biological activities meeting criteria for thymic hormones. During the last 15 yr TFX has been evaluated independently by several Polish medical centers in over 1000 patients with symptomatically different but pathogenically similar human diseases, including primary immunodeficient states, bone marrow failure, autoimmune disorders, chronic skin diseases, recurrent viral and bacterial infectious diseases and some oncological disorders. Long term immunotherapy with TFX--expressing the pro-host approach--resulted, in the majority of the observed patients, in amelioration of symptoms and signs of the disease and in parallel normalization of disturbed immune parameters. It is suggested that IFX (and perhaps other thymic hormones) would support, modify and enrich future treatment protocols, especially in patients with immunodeficiency-related or chronic immune-mediated diseases.

Suzuki H, Yamamoto S, Hirayama C, Takino T, Fujisawa K, Oda T. Cianidanol therapy for HBs-antigen-positive chronic hepatitis: A muticentre, double-blind study. Liver 1986 Feb;6(1):35-44.
Abstract: The effect of cianidanol on the HBeAg/anti-HBe system in 338 patients with HBeAg-positive chronic hepatitis was studied in a double-blind, randomised, placebo-controlled, multicentre clinical trial. 174 patients received cianidanol in a daily dose of 1.5 g for 2 weeks, followed by 2.25 g for a further 14 weeks. 164 patients received a placebo for the same period: patients were followed up for a further 8 weeks. HBeAg and anti-HBe antibody titers were measured by R.I.A. at 4-week intervals and the results were expressed as a "cut-off index" and "inhibition percent", respectively. Liver function tests were also monitored at the same intervals. The HBeAg titer decreased by at least 50% in 44 of 144 cases treated with cianidanol (21 of 140 cases treated with placebo). The difference was significant (p less than 0.01). The HBeAg disappeared in 16 of the cianidanol cases and four of the placebo (p less than 0.05) and a seroconversion was observed in six cianidanol patients and three placebo patients. The mean HBeAg titer in the cianidanol group was significantly lower than that in the placebo group at the end of the 16 weeks of therapy (p less than 0.05). The patients whose HBeAg titer was lowered were largely those with chronic active hepatitis and had higher initial values of SGPT, SGOT and gamma-globulin than the patients whose HBeAg titers remained unchanged. The mean values for these liver function tests also fell significantly in the former sub-group. The drug was well tolerated, the only notable side effect being a transient febrile reaction in 13 patients. It is concluded that cianidanol is a useful and well-tolerated drug for improving the HBeAg/anti-HBe system in patients with HBeAg-positive chronic active hepatitis.

von Herbay A, Stahl W, Niederau C, von Laar J, Strohmeyer G, Sies H. Diminished plasma levels of vitamin E in patients with severe viral hepatitis. Free Radic Res 1996 Dec;25(6):461-466.
Abstract: RRR-alpha-Tocopherol (Vitamin E) was assayed in plasma of 48 patients with viral hepatitis and of 32 healthy controls. In patients with highly elevated serum transaminases (ALT > 100 U/L) vitamin E plasma levels were significantly lower (17.5 +/- 4.8 mumol/L) than in controls (22.7 +/- 4.2 mumol/L, p < 0.01). The vitamin E/lipid ratios (3.12 +/- 0.63 mumol/g) in these patients were 33% lower than those of the controls (4.68 +/- 0.54 mumol/g). The lowered vitamin E levels in patients with acute or chronic viral hepatitis with high activity of disease may be due to free radical-mediated liver injury.

von Herbay A, Stahl W, Niederau C, Sies H. Vitamin E improves the aminotransferase status of patients suffering from viral hepatitis C: a randomized, double-blind, placebo-controlled study. Free Radic Res. 1997 Dec;27(6):599-605.
Abstract: Vitamin E has been shown to protect against liver damage induced by oxidative stress in animal experiments. Based on our previous findings of diminished vitamin E levels in patients suffering from viral hepatitis, we treated 23 hepatitis C patients refractory to alpha-interferon therapy with high doses of vitamin E (2 x 400 IU RRR-alpha-tocopherol/day) for 12 weeks. Study design: pro-spective randomized double-blind crossover design. Clinical parameters including alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were determined for monitoring the disease state, in parallel vitamin E plasma levels and plasma lipids were determined. The plasma levels of the alpha-tocopherol were increased about 2-fold in all 23 patients. In 11 of 23 patients the clinical parameters indicative of liver damage were improved during the phase of vitamin E treatment (48% responders). ALT levels in responders were lowered by 46% and AST levels were lowered by 35% after 12 weeks of vitamin E treatment. Cessation of vitamin E treatment was followed by a rapid relapse of ALT and AST elevation, whereas retreatment led to a reproducible ALT decrease by 45% and AST decrease of 37% after a 6 months followup. Since vitamin E is non-toxic even at elevated doses ingested over extended periods, we suggest the treatment of patients refractory to alpha-interferon therapy suffering from hepatitis C with vitamin E as a supportive therapy.

Yurdakok M, Kanra G. Vitamin E therapy in viral hepatitis. Mikrobiyol Bul 1986;20:91-94 [Article in Turkish]
Abstract: Vitamin E therapy was compared with no treatment in a randomized, prospective trial for treatment of viral hepatitis in children. Patients received either vitamin E. (n:21), 300 mg./day intramuscularly every 24 hours, for seven days, or no treatment (n:20). The mean age (6.6 and 6.2), sex ratio, and the mean duration of illness before administration to study of two groups were similar. No difference was noted in the mean serum transaminases and alkaline phosphatase levels between both groups.

Zeman K, Dworniak D, Tchorzewski H, Pokoca L, Majewska E. Related Articles Effect of thymic extract on allogeneic MLR and mitogen-induced responses in patients with chronic active hepatitis B. Immunol Invest. 1991 Dec;20(7):545-555.
Abstract: Cell-mediated immune reactions are involved in the development of chronic active hepatitis (CAH-B). The present studies confirm that lymphocyte from patients with CAH-B have a decreased allogeneic mixed lymphocyte reaction (allo-MLR) and mitogen-induced responses. These abnormalities probably play a role in the immunological dysfunctions underlying chronic liver diseases. Twenty one patients with biopsy-proven CAH-B and a significantly lowered CD4:CD8 cell number ratio were treated with thymic extract (Thymomodulin-TFX) for 6 months. The results of immunological, serological and biochemical findings indicate that this preparation has an immunoregulatory action and produces beneficial clinical effect in patients with CAH-B.