DESCRIPTION

Hepatitis is an inflammation of the liver, usually caused by a viral infection.

The liver is responsible for filtering out from th bloodstream harmful substances such as dead cells, toxins, fats, and overabundance of hormones, and a yellowish substance called bilirubin that is a by-product of the breakdown of old red blood cells.

If the liver becomes inflamed, tender and enlarged. it becomes unable to function normally. As a result, toxins that would normally be filtered out by the liver build up in the body, and certain nutrients are not processed and stored the way they should be.

Viral hepatitis is the most common of all serious contagious diseases, affecting as many as 500,000 Americans each year. Hepatitis is often misdiagnosed because it is often mistaken for the flu.

The various types of viral hepatitis all cause infection and inflammation of the liver, but each type is contracted in a different way. The acute phase of the disease lasts approximately two to three weeks; complete recovery usually takes nine weeks. Most patients recover fully with a lifelong immunity to the disease; 1 percent of all cases die in the acute phase; some develop chronic hepatitis with liver inflammation that lasts six months or more, resulting in cirrhosis and possibly death.

There are different types of hepatitis, classified according to the virus that causes the condition. The most common are type A, type B and type C. Other types less common include hepatitis D, E, and G. In the last 15 years, scientists have identified the viruses responsible for the three leading types of the disease (A,B,and C). Each of these types have many subtypes within that determine greatly through studies and therapies whether or not the infected person will respond to a specific therapy (such as interferon therapy). All types of viral hepatitis is contagious to some extent.

In addition to the hepatitis viruses (please note that the hepatitis viruses are not all related), other viruses can also cause hepatitis (inflammation of the liver), including cytomegalovirus, Epstein-Barr virus, yellow fever, mumps virus, rubella virus, etc.

There are many other non-viral causes for hepatitis including alcohol and drug use, metabolic causes, and others. See types of hepatitis below for a more detailed description.

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TYPES OF HEPATITIS

HEPATITIS A

HEPATITIS A OVERVIEW

Hepatitis A virus (HAV), also known infectious hepatitis, can cause acute liver disease. In most cases, however, the liver heals within a few months. Hepatitis A can develop without sudden signs or symptoms. It is easily spread through person-to-person contact, and through contact with food, clothing, bed linen, and other items. It is contracted orally or through fecal contamination of food and water. Hepatitis A usually spreads through improper handling of food, close contact with family members or children in day-care centers, and eating shellfish taken from polluted waters. It is contagious between two and three weeks before and one week after jaundice appears. After a bout with hepatitis A, the individual develops an immunity to it. It is the least dangerous form of the disease because it clears up on its own and it rarely results in chronic liver inflammation.

HEPATITIS A DEFINITION: Hepatitis A is an inflammation of the liver caused by a virus, the hepatitis A virus (HAV). It varies in severity, running an acute course, generally starting within two to six weeks after contact with the virus, and lasting no longer than two or three months. HAV may occur in single cases after contact with an infected relative or sex partner. Alternately, epidemics may develop when food or drinking water is contaminated by the feces of an infected person. HEPATITIS A DESCRIPTION: Hepatitis A was previously known as infectious hepatitis because it spread relatively easily from those infected to close household contacts. Once the infection ends, there is no lasting, chronic phase of illness. However it is not uncommon to have a second episode of symptoms about a month after the first; this is called a relapse, but it is not clear that the virus persists when symptoms recur. Both children and adults may be infected by HAV. Children are the chief victims, but very often have no more than a flu-like illness or no symptoms at all (so-called "subclinical" infection), whereas adults are far likelier to have more severe symptoms. Epidemics of HAV infection can infect dozens and even hundreds (or, on rare occasions, thousands) of persons. In the public's mind, outbreaks of hepatitis A usually are linked with the eating of contaminated food at a restaurant. It is true that food-handlers, who may themselves have no symptoms, can start an alarming, widespread epidemic. Many types of food can be infected by sewage containing HAV, but shellfish, such as clams and oysters, are common culprits. Apart from contaminated food and water, certain groups are at increased risk of getting infectious hepatitis: Children at day care centers make up an estimated 14-40 percent of all cases of HAV infection in the United States. Changing diapers transmits infection through fecal-oral contact. Toys and other objects may remain contaminated for some time. Often a child without symptoms brings the infection home to siblings and parents. Troops living under crowded conditions at military camps or in the field. During World War II there were an estimated five million cases in German soldiers and civilians. Anyone living in heavily populated and squalid conditions, such as the very poor and those placed in refugee or prisoner-of-war camps. Homosexual men are increasingly at risk of HAV infection from oral-anal sexual contact. Travelers visiting an area where hepatitis A is common are at risk of becoming ill. CAUSES & SYMPTOMS: The time from exposure to HAV and the onset of symptoms ranges from two to seven weeks and averages about a month. The virus is passed in the feces, especially late during this incubation period, before symptoms first appear. Infected persons are most contagious starting a week or so before symptoms develop, and remain so up until the time jaundice (yellowing of the skin) is noted. Often the first symptoms to appear are fatigue, aching all over, nausea, and a loss of appetite. Those who like drinking coffee and smoking cigarettes may lose their taste for them. Mild fever is common; it seldom is higher than 101°F (38.3°C). The liver often enlarges, causing pain or tenderness in the right upper part of the abdomen. Jaundice then develops, typically lasting seven to ten days. Many patients do not visit their health care provider until their skin turns yellow. As many as three out of four children have no symptoms of HAV infection, but about 85 percent of adults will have symptoms. Besides jaundice, the commonest are abdominal pain, loss of appetite, and feeling generally poorly. SPECIAL SITUATIONS: An occasional patient with hepatitis A will remain jaundiced for a month, two months or even longer, but eventually the jaundice will pass. Very rarely, a patient will develop such severe hepatitis that the liver fails. HAV infection causes about 100 deaths each year in the United States. In developed countries, a pregnant woman who contracts hepatitis A can be expected to do well although a different form of viral hepatitis (hepatitis E) can cause severe infection in pregnant women. In developing countries, however, the infection may prove fatal, probably because nutrition is not adequate. DIAGNOSIS: The early, flu-like symptoms and jaundice, as well as rapid recovery, suggest infectious hepatitis without special tests being done. If there is any question, a specialist in gastrointestinal disorders or infectious diseases can confirm the diagnosis - the detection of a specific antibody, called hepatitis A IgM antibody, that develops when HAV is present in the body. This test always registers positive when a patient has symptoms, and should continue to register positive for four to six months. However, hepatitis A IgM antibody will persist lifelong in the blood and is protective against reinfection. TREATMENT: Once symptoms appear, no antibiotics or other medicines will shorten the course of infectious hepatitis. Patients should rest in bed as needed, take a healthy diet, and avoid drinking alcohol and/or any medications that could further damage the liver. If a patient feels well it is all right to return to school or work even if some jaundice remains.

HEPATITIS B

HEPATITIS B OVERVIEW

Hepatitis B virus (HBV), also referred to as serum hepatitis, is the most widespread form of the disease. It is spread through contact with infected blood (for example, through the use of contaminated syringes, needles, and transfused blood) and some forms of sexual activity. It can be passed from mother to child at or shortly following birth and can be spread from adults to children in the same family. It is estimated that up to 5 percent of all Americans, and as many as 85 percent of gay men, are infected with hepatitis B. However, most hepatitis B infections come and go unrecognized and about 1/3 of all hepatitis B cases cannot be traced to a reliable source. Most hepatitis B sufferers (about 85 percent) recover fully from HBV, although a small percentage of cases do not recover and go on to develop cirrhosis or cancer of the liver. In some 10 to 15 percent of cases, the disease becomes chronic, scarring the liver and making it more vulnerable to cancer. Hepatitis B is the ninth leading cause of death in the United States.

HEPATITIS B DEFINITION: Hepatitis B is a potentially serious form of liver inflammation due to infection by the hepatitis B virus (HBV). It occurs in both rapidly developing (acute) and long-lasting (chronic) forms, and is one of the most common chronic infectious diseases worldwide. An effective vaccine is available that will prevent the disease in those who are later exposed. HEPATITIS B DESCRIPTION: Commonly called "serum hepatitis," hepatitis B ranges from mild to severe. Some people who are infected by HBV develop no symptoms and are totally unaware of the fact, but they may carry HBV in their blood and pass the infection on to others. In its chronic form, HBV infection may destroy the liver through a scarring process, called cirrhosis, or it may lead to cancer of the liver. When a person is infected by HBV, the virus enters the bloodstream and body fluids, and is able to pass through tiny breaks in the skin, mouth, or the male or female genital area. There are several ways of getting the infection: During birth, a mother with hepatitis B may pass HBV on to her infant. Contact with infected blood is a common means of transmitting hepatitis B. One way this may happen is by being stuck with a needle. Both health care workers and those who inject drugs into their veins are at risk in this way. Having sex with a person infected by HBV is an important risk factor (especially anal sex). Although there are many ways of passing on HBV, the virus actually is not very easily transmitted. There is no need to worry that casual contact, such as shaking hands, will expose one to hepatitis B. There is no reason not to share a workplace or even a restroom with an infected person. More than 300 million persons throughout the world are infected by HBV. While most who become chronic carriers of the virus live in Asia and Africa, there are no fewer than 1.5 million carriers in the United States. Because carriers represent a constant threat of transmitting the infection, the risk of hepatitis B is always highest where there are many carriers. Such areas are said to be endemic for hepatitis B. When infants or young children living in an endemic area are infected, their chance of becoming a chronic hepatitis B carrier is at least 90 percent. This probably is because their bodies are not able to make the substances (antibodies) that destroy the virus. In contrast, no more than 5 percent of infected teenagers and adults develop chronic infection. CAUSES & SYMPTOMS: With the exception of HBV, all the common viruses that cause hepatitis are known as RNA viruses because they contain ribonucleic acid or RNA as their genetic material. HBV is the only deoxyribonucleic acid or DNA virus that is a major cause of hepatitis. HBV is made up of several fragments, called antigens, that stimulate the body's immune system to produce the antibodies that can neutralize or even destroy the infecting virus. It is, in fact, the immune reaction, not the virus, that seems to cause the liver inflammation. Acute Hepatitis B: In the United States, a majority of acute HBV infections occur in teenagers and young adults. Half of these youth never develop symptoms, and only about 20 percent - or one in five infected patients - develop severe symptoms and yellowing of the skin (jaundice). Jaundice occurs when the infected liver is unable to get rid of certain colored substances, or pigments, as it normally does. The remaining 30 percent of patients have only "flu-like" symptoms and will probably not even be diagnosed as having hepatitis unless certain tests are done. The most common symptoms of acute hepatitis B are loss of appetite, nausea, generally feeling poorly, and pain or tenderness in the right upper part of the abdomen (where the liver is located). Compared to patients with hepatitis A or C, those with HBV infection are less able to continue their usual activities and require more time resting in bed. Occasionally patients with HBV infection will develop joint swelling and pain (arthritis) as well as hives or a skin rash before jaundice appears. The joint symptoms usually last no longer than three to seven days. Typically the symptoms of acute hepatitis B do not persist longer than two or three months. If they continue for four months, the patient has an abnormally long-lasting acute infection. In a small number of patients - probably fewer than 3 percent - the infection keeps getting worse as the liver cells die off. Jaundice deepens, and patients may bleed easily when the levels of coagulation factors (normally made by the liver) decrease. Large amounts of fluid collect in the abdomen and beneath the skin (edema). The least common outcome of acute HBV infection, seen in fewer than 1 percent of patients, is fulminant hepatitis, when the liver fails entirely. Only about half of these patients can be expected to live. Chronic Hepatitis B: HBV infection lasting longer than six months is said to be chronic. After this time it is much less likely for the infection to disappear. Not all carriers of the virus develop chronic liver disease; in fact, a majority have no symptoms. But, about one in every four HBV carriers develop liver disease that gets worse over time, as the liver becomes more and more scarred and less able to carry out its normal functions. A badly scarred liver is called cirrhosis. Patients are likely to have an enlarged liver and spleen, as well as tiny clusters of abnormal blood vessels in the skin that resemble spiders. The most serious complication of chronic HBV infection is liver cancer. Worldwide this is the most common cancer to occur in men. Nevertheless, the overall chance that liver cancer will develop at any time in a patient's life is probably much lower than 10 percent. Patients with chronic hepatitis B who drink or smoke are more likely to develop liver cancer. It is not unusual for a person to simultaneously have both HBV infection and infection by HIV (human immunodeficiency virus, the cause of AIDS). A study released in 2003 reported that men infected with both HIV and HBV were more likely to die from liver disease than people infected with just one of the diseases. DIAGNOSIS OF HEPATITIS B: Hepatitis B is diagnosed by detecting one of the viral antigens - called hepatitis B surface antigen (HBsAg) - in the blood. Later in the acute disease, HBsAg may no longer be present, in which case a test for antibodies to a different antigen - hepatitis B core antigen - is used. If HBsAg can be detected in the blood for longer than six months, chronic hepatitis B is diagnosed. A number of tests can be done to learn how well, or poorly, the liver is working. They include blood clotting tests and tests for enzymes that are found in abnormally high amounts when any form of hepatitis is present. Hepatitis B virus (HBV) is composed of an inner protein core and an outer protein capsule. The outer capsule contains the hepatitis B surface antigen (HBsAg). The inner core contains HBV core antigen (HBcAg) and hepatitis B e-antigen (HBeAg). This cell also contains polymerase, which catalyzes the formation of the cell's DNA. HBV is the only hepatitis-causing virus that has DNA, instead of RNA. TREATMENT: In the past, there was no treatment available for hepatitis B. But developments have been made in recent years on drugs that suppress the virus and its symptoms. In early 2003, a drug called adefovir was reported as an effective treatment. Another drug called tenofovir was demonstrated as effective in patients infected with both hepatitis B and HIV. Two studies also reported on the effectiveness of a drug called Preveon, which was more expensive than others. Patients also should rest in bed as needed, continue to eat a healthy diet, and avoid alcohol. Any non-critical surgery should be postponed. PROGNOSIS: Each year an estimated 150,000 persons in the United States get hepatitis B. More than 10,000 will require hospital care, and as many as 5,000 will die from complications of the infection. About 90 percent of all those infected will have acute disease only. A large majority of these patients will recover within three months. It is the remaining 10 percent, with chronic infection, who account for most serious complications and deaths from HBV infection. In the United States, perhaps only 2 percent of all those who are infected will become chronically ill. The course of chronic HBV infection in any particular patient is unpredictable. Some patients who do well at first may later develop serious complications. Even when no symptoms of liver disease develop, chronic carriers remain a threat to others by serving as a source of infection. PREVENTION: The best way to prevent any form of viral hepatitis is to avoid contact with blood and other body fluids of infected individuals. The use of condoms during sex also is advisable. If a person is exposed to hepatitis B, a serum preparation containing a high level of antibody against HBV may prevent infection if given within three to seven days of exposure. Babies born of a mother with HBV should receive the vaccine within 24 hours. An effective and safe vaccine is available that reliably prevents hepatitis B. Vaccination is suggested by conventional medical practice for most infants and for children aged 10 and younger whose parents are from a place where hepatitis B is common. Teenagers not vaccinated as children and all adults at risk of exposure also should be vaccinated against hepatitis B. Three doses are recommended. Before you choose to vaccinate, be sure to research the pros and cons of vaccination and become an informed consumer about risks and side effects associated with this controversial method of obtaining immunity to various diseases. MoonDragon's Health & Wellness: Vaccination Awareness Information MoonDragon's Health & Wellness: Vaccination Awareness - Facts About Mercury & Links

HEPATITIS C

HEPATITIS C OVERVIEW

Hepatitis C virus (HCV), was once called non-A-non-B hepatitis, is considered the most serious form of hepatitis. It accounts for 20 to 40 percent of all hepatitis and 90 to 95 percent of hepatitis contracted through blood transfusions and approximately 10,000 deaths a year in America. It is estimated that 4 million Americans are infected with HCV, 3 million of them chronically. Hepatitis C is the primary reason for liver transplants in this country. It is 4 times more prevalent than AIDS and 20 time easier to catch. About 85 percent of infections lead to chronic liver disease. Currently, more that 99 percent of people with HCV survive. The virus causes slowly progressing but ultimately devastating damage to the liver. In addition, people with hepatitis CV often have elevated levels of iron in the liver. This also can cause liver damage.

Tests can now detect antibodies against hepatitis C in donated blood, a major advancement in ensuring a safe blood supply, but an infected individual may take up to six months to develop the antibodies, so it is still impossible to identify all infected blood. The U.S. Food & Drug Administration (FDA) maintains that only 7 percent of current hepatitis C cases were acquired as a result of blood transfusions, and the risk of contacting the virus from a unit of blood is about 1 in 100,000. The incidence of hepatitis C infection from blood transfusions or the use of blood products has decreased since 1992, when screening was introduced, but there is always a risk - and the lack of testing before 1992 has left a huge legacy of HCV-infected people. You may be at risk for hepatitis C if you have:

• Had a blood transfusion prior to 1992, when screening for HCV antibodies started.
• Shared needles for intravenous (IV) drug use (even one incident, years ago.
• Shared straws for cocaine use.
• Had body piercing or tattoos with non-sterile equipment.
• Had hemodialysis (used a kidney machine).
• Had frequent exposure to blood products (due to hemophilia, chronic renal failure, chemotherapy, organ transplantation, or any other reason).
• Had a needle-sticking incident (health care workers at high risk).
• Used an infected person's toothbrush, razor, or other item that had blood on it.
• Engaged in high-risk sexual behavior, such as having multiple partners and using no protection.

Although Hepatitis C can be contracted through intravenous drug use, sexual contact, and broken skin, tattoo needles, or mucous membranes - in 1/3 of all hepatitis C patients, the cause is unknown.

HEPATITIS C DEFINITION: Hepatitis C is a form of liver inflammation that causes primarily a long-lasting (chronic) disease. Acute (newly developed) hepatitis C is rarely observed as the early disease is generally quite mild. Spread mainly by contact with infected blood, the hepatitis C virus (HCV) causes most cases of viral liver infection not due to the A and B hepatitis viruses. In fact, before other viral types were found, hepatitis C was referred to as "non-A, non-B hepatitis." It is not a new infection, just newly diagnosable and has been widely present in the U.S. population for decades. HEPATITIS C DESCRIPTION: HCV is a blood-borne virus that is and always was the major cause of "transfusion hepatitis," which can develop in patients who are given blood or most blood products except for gamma-globulin. The existence of a third hepatitis virus (besides the A and B viruses) became clear in 1974, but HCV was first identified in 1989. Thereafter, tests were devised to detect the virus in blood units before transfusing them. As a result, since the early 1990s transfused blood is less commonly the cause of hepatitis C. The hepatitis C form of hepatitis is generally mild in its early, acute stage, but it is much likelier than hepatitis B (85 percent as compared to 10 percent) to produce chronic liver disease. Therefore, more than two of every three persons who are infected by HCV may continue to have the virus in their blood and so become carriers, who can transmit the infection to others. The most common way of transmitting hepatitis C is when blood containing the virus enters another person's circulation through a break in the skin or the mucosa (inner lining) of the mouth or genitals. HCV also can be passed (although uncommonly) from an infected mother to the infant she is carrying. (The risk of infection from breast milk is very low.) Also, HCV can be rarely spread through sexual intercourse. Usually, however, the sexual contacts of chronic carriers of hepatitis C are not infected. Those at increased risk of developing hepatitis C include: Healthcare workers who come in contact with infected blood from a cut or bruise, or from a device or instrument that has been infected ("contaminated"). Persons who inject illicit drugs into their veins and skin, especially if they share needles and syringes with other users. Anyone who gets a tattoo or has his or her skin pierced with an infected needle. Persons with hemophilia (who because they bleed very easily may require large amounts of blood and blood products over time). Patients with kidney disease who have periodic dialysis - a treatment that rids their blood of toxic substances - and often requires the patient to have blood transfusions. About one-fourth of patients with hepatitis C do not belong to any of these high-risk groups. Although blood transfusion is a much less common cause of HCV infection than in earlier years, cases still occur. Also, sexual transmission is possible, and may take place with either heterosexual or homosexual behavior. CAUSES & SYMPTOMS: More than half of all patients who develop hepatitis C have no symptoms or signs of liver disease. Some, however, may have a minor illness with flu-like symptoms. Any form of hepatitis may keep the liver from eliminating certain colored (pigmented) substances as it normally does. These pigments collect in the skin, turning it yellow, and also may cause yellowing of the whites of the eyes. About one in four patients with hepatitis C will develop this yellowing of the skin called jaundice (or yellow jaundice). Some patients lose their appetite and frequently feel tired. Patients may also feel nauseous or even vomit. In most patients, HCV can still be found in the blood six months after the start of acute infection, and these patients are considered to be carriers. If the virus persists for one year, it is very unlikely to disappear. About 20 percent of chronic carriers develop cirrhosis (scarring) of the liver when the virus damages or destroys large numbers of liver cells, which are then replaced by scar tissue. Cirrhosis may develop only after a long period of time (as long as 20 years) and often even more has passed. Most (four in five) patients will not develop cirrhosis and instead have a mild, chronic form of infection called chronic persistent hepatitis and when they die, will die with, not of, the infection. Patients with chronic HCV infection are at risk of developing certain very serious complications: Patients with hepatitis C who develop cirrhosis may go on to have liver cancer - called hepatocellular carcinoma. Patients with liver cancer have an average life expectancy measured in months unless the tumor is totally removed. Patients also are at risk of developing a combination of joint pain, weakness, and areas of bleeding into the skin. The kidneys and brain also may be affected. Perhaps 5 percent of patients with chronic HCV infection develop this condition, called cryoglobulinemia. Patients with porphyria (metabolic disturbances characterized by extreme sensitivity to light) develop blisters in areas of their skin that are exposed to sunlight. The skin also may be easily bruised, and, in time, can become discolored. HCV DIAGNOSIS: Hepatitis C should be suspected if a patient develops jaundice and reports recent contact with the blood of a person who may have been infected. There is a blood test to detect HCV IgG antibody, a substance that the body makes to combat HCV. Care is required, as the test often does not show positive for up to two to three months after infection. Also, the test only shows whether a person has ever been infected by HCV, not whether the virus is still present. A less available and more expensive test measuring HCV RNA (the viral gene) can be found in early infection before the antibody is measurable. Simpler blood tests can be done to show how much jaundice-causing pigment is in a patient's blood, or to measure the levels of certain proteins made by the liver. High levels of these "liver enzymes" (called ALT and AST) indicate that the liver is inflamed. Rising levels could suggest that the infection is getting worse. HCV TREATMENT: Patients who fail to recover promptly may be advised to see a specialist in gastrointestinal disorders (which include liver disease) or infectious diseases. A balanced diet with little fat is best, and patients should limit their alcohol intake, or, better, avoid alcohol altogether. Any medication that can cause liver damage should be avoided. The amount of time in bed depends on how poorly a particular patient feels. A natural body protein, interferon alpha, now can be made in large amounts by genetic engineering, and improves the outlook for many patients who have chronic hepatitis C. The protein can lessen the symptoms of infection and improve liver function. Tests may be done to monitor patient therapy (HCV bDNA Testing, PCR Tests to monitor viral loads and detection). Not all patients respond, however, and others get less benefit the longer they take interferon. Genotyping of HCV can help practitioners predict which patients will benefit from interferon therapy (some genotypes [subtypes of HCV] respond better than other genotypes to this type of therapy). Fever and flu-like symptoms are frequent side effects of this treatment. Using a high dose for six months, nearly half of patients have responded positively. Half the patients who do respond well will relapse after the drug is stopped. A newer medication called ribavirin is now commonly used with interferon and, if tolerated, does increase response rates. A newer form of interferon, called pegylated interferon, is also being used for treatment. Because of the problems with treatment, many people have sought alternative medications such as Milk Thistle or certain Asian herbs (TCM herbal therapy). When hepatitis destroys most or all of the liver, the only hope may be a liver transplant. Unfortunately the new liver usually becomes infected by HCV. On the other hand, total liver failure is less frequent than in patients with hepatitis B. There are strict medical guidelines for those patients applying for a liver transplant and not every HCV patient qualifies for this procedure. PROGNOSIS: In roughly one-fifth of patients who develop hepatitis C, the acute infection will subside, and they will recover completely within four to eight weeks and have no later problems. Other patients face two risks: they themselves may develop chronic liver infection and possibly serious complications such as liver cancer, and, also, they will continue carrying the virus and may pass it on to others. The overall risk of developing cirrhosis, or liver scarring, is about 15 percent of all patients infected by HCV. Acute liver failure is less frequent in patients with chronic hepatitis C than in those with other forms of hepatitis. PREVENTION: No vaccine has yet been developed to prevent hepatitis C in persons exposed to the virus. In addition, there is no role of gamma-globulin in the prevention of the infection. There are, however, many ways in which infection may be avoided: Those who inject drugs should never share needles, syringes, swabs, spoons, or anything else that comes in contact with bodily fluids. They should always use clean equipment. Hands should be washed before and after contact with another person's blood or if the skin is penetrated. The sharing of personal items should be avoided, particularly those that can puncture the skin or inside of the mouth, such as razors, nail files and scissors, and even toothbrushes. Condoms should be used for either vaginal or oral sex. If a person does develop hepatitis C, its spread may be prevented by: Not donating blood. Not sharing personal items with others. wiping up any spilled blood while using gloves, household bleach, and disposable paper towels. Clinical labs use a 10 percent bleach solution (9 parts water to 1 part bleach) to clean and maintain their working spaces where infected blood is tested. Carefully covering any cut or wound with a band-aid or dressing. Practicing safe sex, especially during the acute phase of the infection.

HEPATITIS D

HEPATITIS D OVERVIEW

Hepatitis D virus (HDV), or delta hepatitis, occurs in some people with hepatitis B and intensifies the symptoms of that form of the disease. It is the least common of all the hepatitis viruses, but the most serious and dangerous form because it means that there are two types of hepatitis working together at once. It can be spread from mother to child and through sexual contact.

HEPATITIS D DEFINITION: Hepatitis D (or delta, the Greek letter "D"), is a form of liver inflammation that occurs only in patients who also are infected by the hepatitis B virus. Infection by the hepatitis delta virus (HDV) either occurs at the same time as hepatitis B develops, or develops later when infection by hepatitis B virus (HBV) has entered the chronic (long-lasting) stage. HEPATITIS D DESCRIPTION: Delta hepatitis can be quite severe, but it is seen only in patients already infected by HBV. In the late 1970s, Italian physicians discovered that some patients with hepatitis B had another type of infectious agent in their liver cells. Later the new virus - HDV - was confirmed by experimentally infecting chimpanzees. When both viruses are present, acute infection tends to be more severe. Furthermore, patients with both infections are likelier than those with HBV alone to develop chronic liver disease, and, when it occurs, it is more severe. About 300 million persons worldwide carry HBV. Of them, at least 5 percent probably also have delta hepatitis. In North America HDV infection appears to be less frequent: 4 percent of all patients with acute hepatitis B have HDV infection. The delta virus causes an estimated 2 percent of all cases of acute viral hepatitis in the United States. The rate of HDV infection varies widely in different parts of the world; it is a very serious infection in some countries and quite mild in others. Chronic delta hepatitis is a more serious disease than either chronic hepatitis B alone or hepatitis C. Certain individuals - the same ones who are at increased risk of developing hepatitis B - are the prime candidates to be infected by HDV. For example: Not infrequently, HDV infection occurs in patients with chronic HBV infection who also have hemophilia, a bleeding disease. These patients are at risk because they require large amounts of transfused blood and blood products that may contain HDV. In some areas, one-fourth to one-half of patients with chronic HBV infection who inject themselves with illicit drugs become infected by HDV as well. Drug abusers who share contaminated needles are likely to infect one another. Patients who get HBV infection by sexual contact may also be infected by HDV, although the delta virus is less often spread in this way than is HBV itself. Between 10-25 percent of homosexual men with chronic HBV infection harbor the delta virus. Like hepatitis B, HDV infection may develop in healthcare workers who are victims of a needle stick, and it also can be spread within households when personal items such as a razor or toothbrush are shared. CAUSES & SYMPTOMS: The delta virus is a small and incomplete viral particle. Perhaps this is why it cannot cause infection on its own. Its companion virus, HBV, actually forms a covering over the HDV particle. In chronically ill patients (those whose virus persists longer than six months), the combined viruses cause inflammation throughout the liver and eventually destroy the liver cells, which are then replaced by scar tissue. This scarring is called cirrhosis. When HBV and HDV infections develop at the same time, a condition called co-infection, recovery is the rule. Only 2-5 percent of patients become chronic carriers (have the virus remain in their blood more than six months after infection). It may be that HDV actually keeps HBV from reproducing as rapidly as it would if it were alone, so chronic infection is less likely. When HBV infection occurs first and is followed by HDV infection, the condition is called superinfection. This is a more serious situation. Between half and two-thirds of patients with superinfection develop severe acute hepatitis. Once the liver cells contain large numbers of HBV viruses, HDV tends to reproduce more actively. Massive infection and liver failure are more common in superinfection. The risk of liver cancer, however, is no greater than from hepatitis B alone. As with other forms of hepatitis, the earliest symptoms are nausea, loss of appetite, joint pains, and tiredness. There may be fever (not marked) and an enlarged liver may cause discomfort or actual pain in the right upper part of the abdomen. Later, jaundice (a yellowing of the skin and whites of the eyes that occurs when the liver is no longer able to eliminate certain pigmented substances) may develop. DIAGNOSIS: HDV infection may be diagnosed by detecting the antibody against the virus. Unfortunately this test cannot detect acute co-infection or superinfection as early as when symptoms first develop. Antibody against HDV usually is found no sooner than 30 days after symptoms appear. Until recently, the virus itself could only be identified by testing a small sample of liver tissue. Scientists now are developing a blood test for HDV that should make diagnosis faster and easier. When HDV is present, liver enzymes (proteins made by the liver) are present in abnormally high amounts. In some patients with co-infection, the enzyme levels peak twice, once when HBV infection starts and again at the time of HDV infection. TREATMENT: As in any form of hepatitis, patients in the acute stage should rest in bed as needed, eat a balanced diet, and avoid alcohol. Alpha-interferon, the natural body substance which helps control hepatitis C, has generally not been found helpful in treating hepatitis D. If the liver is largely destroyed and has stopped functioning, liver transplantation is an option. Even when the procedure is successful, disease often recurs and cirrhosis may actually develop more rapidly than before. PROGNOSIS: A large majority of patients with co-infection of HBV and HDV recover from an episode of acute hepatitis. However, about two-thirds of patients chronically infected by HDV go on to develop cirrhosis of the liver. In one long-term study, just over half of patients who became carriers of HDV had moderate or severe liver disease, and one-fourth of them died. If very severe liver failure develops, the chance of a patient surviving is no better than 50 percent. A liver transplant may improve this figure to 70 percent. When transplantation is done for cirrhosis, rather than for liver failure, nearly 90 percent of patients live five years or longer. The major concern with transplantation is infection of the transplanted liver; this may occur in as many as 40 percent of transplant patients. When a child with viral hepatitis develops cirrhosis, HDV infection is commonly responsible. A woman who develops delta hepatitis while pregnant will do as well as if she were not pregnant; and there is no increased risk that the newborn will be malformed in any way. PREVENTION: The vaccine against hepatitis B also prevents delta hepatitis, since it cannot occur unless HBV infection is present. Hopefully, a vaccine can be developed that will keep delta infection from developing in chronic HBV carriers. However, if a person already has HBV infection, any exposure to blood should be strictly avoided. A high level of sexual activity with multiple partners is also a risk factor for delta hepatitis.

HEPATITIS E

HEPATITIS E OVERVIEW

Hepatitis E virus (HEV) is rare in the United States, but more common in other parts of the world, notably Mexico, India, African and Asian countries. Only a few cases are seen in the U.S. each year, mostly in people who traveled to the afore mentioned countries. It is usually spread through fecal contamination and appears to be dangerous for pregnant women, but generally does not lead to chronic hepatitis in others.

HEPATITIS E DEFINITION: The hepatitis E virus (HEV) is a common cause of hepatitis that is transmitted via the intestinal tract, and is not caused by the hepatitis A virus. Spread most often by contaminated drinking water, HEV infection occurs mainly in developing countries. HEPATITIS E DESCRIPTION: Hepatitis E is also known as epidemic non-A, non-B hepatitis. Like hepatitis A, it is an acute and short-lived illness that can sometimes cause liver failure. HEV, discovered in 1987, is spread by the fecal-oral route. It is constantly present (endemic) in countries where human waste is allowed to get into drinking water without first being purified. Large outbreaks (epidemics) have occurred in Asian and South American countries where there is poor sanitation. In the United States and Canada no outbreaks have been reported, but persons traveling to an endemic region may return with HEV. CAUSES & SYMPTOMS: There are at least two strains of HEV, one found in Asia and another in Mexico. The virus may start dividing in the gastrointestinal tract, but it grows mostly in the liver. After an incubation period (the time from when a person is first infected by a virus until the appearance of the earliest symptoms) of two to eight weeks, infected persons develop fever, may feel nauseous, lose their appetite, and often have discomfort or actual pain in the right upper part of the abdomen where the liver is located. Some develop yellowing of the skin and the whites of the eyes (jaundice). Most often the illness is mild and disappears within a few weeks with no lasting effects. Children younger than 14 years and persons over age 50 seldom have jaundice or show other clinical signs of hepatitis. Hepatitis E never becomes a chronic (long-lasting) illness, but on rare occasions the acute illness damages and destroys so many liver cells that the liver can no longer function. This is called fulminant liver failure, and may cause death. Pregnant women are at much higher risk of dying from fulminant liver failure; this increased risk is not true of any other type of viral hepatitis. The great majority of patients who recover from acute infection do not continue to carry HEV and cannot pass on the infection to others. DIAGNOSIS: HEV can be found by microscopically examining a stool sample, but this is not a reliable test, as the virus often dies when stored for a short time. Like other hepatitis viruses, HEV stimulates the body's immune system to produce a substance called an antibody, which can swallow up and destroy the virus. Blood tests can determine elevated antibody levels, which indicate the presence of HEV virus in the body. Unfortunately, such antibody blood tests are not widely available. TREATMENT: There is no way of effectively treating the symptoms of any acute hepatitis, including hepatitis E. During acute infection, a patient should take a balanced diet and rest in bed as needed. PROGNOSIS: In the United States hepatitis E is not a fatal illness, but elsewhere about 1-2 percent of those infected die of advanced liver failure. In pregnant women the death rate is as high as 20 percent. It is not clear whether having hepatitis E once guarantees against future HEV infection. PREVENTION: Most attempts to use blood serum containing HEV antibody to prevent hepatitis in those exposed to HEV have failed. Hopefully, this approach can be made to work so that pregnant women living in endemic areas can be protected. No vaccine is available, though several are being tested. It also is possible that effective anti-viral drugs will be found. The best ways to prevent hepatitis E are to provide safe drinking water and take precautions to use sterilized water and beverages when traveling.

HEPATITIS G



HEPATITIS G OVERVIEW

GB virus C (GBV-C), formerly known as Hepatitis G virus (HGV), is a species of virus in the Flaviviridae family which has not yet been assigned to a genus, is known to infect humans, but is not known to cause human disease. There have been reports that HIV patients co-infected with GBV-C can survive longer than those without GBV-C, but the patients may be different in other ways. There is current active research into the virus' effects on the immune system in patients co-infected with GBV-C and HIV.

GBV-C is a member of the Flaviviridae family and is phylogenetically related to hepatitis C virus but appears to replicate primarily in lymphocytes, and poorly if at all in hepatocytes. GBV-A and GBV-B are probably Tamarin viruses, while GBV-C infects humans.

HEPATITIS G DEFINITION: Hepatitis G is a newly discovered form of liver inflammation caused by hepatitis G virus (HGV), a distant relative of the hepatitis C virus. HEPATITIS G DESCRIPTION: Hepatitis G virus and GB virus C (GBV-C) are RNA viruses that were independently identified in 1995 and was first described early in 1996. These were subsequently found to be two isolates of the same virus. Although GBV-C was initially thought to be associated with chronic hepatitis, extensive investigation failed to identify any association between this virus and any clinical illness. Little is known about the frequency of HGV infection, the nature of the illness, or how to prevent it. What is known is that transfused blood containing HGV has caused some cases of hepatitis. For this reason, patients with hemophilia and other bleeding conditions who require large amounts of blood or blood products are at risk of hepatitis G. HGV has been identified in between 1-2 percent of blood donors in the United States. Also at risk are patients with kidney disease who have blood exchange by hemodialysis, and those who inject drugs into their veins. It is possible that an infected mother can pass on the virus to her newborn infant. Sexual transmission also is a possibility. Often patients with hepatitis G are infected at the same time by the hepatitis B or C virus, or both. In about three of every thousand patients with acute viral hepatitis, HGV is the only virus present. There is some indication that patients with hepatitis G may continue to carry the virus in their blood for many years, and so might be a source of infection in others. HUMAN INFECTION: The majority of immune-competent individuals appear to clear GBV-C viremia within the first few years following infection and although the time interval between GBV-C infection and clearance of viremia (detection of GBV-C RNA in plasma) is not known, infection may persist for decades in some individuals. Approximately 2 percent of healthy US blood donors are viremic with GBV-C, and up to 13 percent of blood donors have antibodies to E2 protein, indicating prior infection. Parenteral, sexual and vertical transmission of GBV-C have all been documented, and because of shared modes of transmission, individuals infected with HIV are commonly co-infected with GBV-C. Among people with HIV infection, the prevalence of GBV-C viremia ranges from 14 to 43 percent. Some studies have suggested that co-infection with GBV-C will actually slow the progression of HIV disease. CAUSES & SYMPTOMS: Some researchers believe that there may be a group of GB viruses, rather than just one. Others remain doubtful that HGV actually causes illness. If it does, the type of acute or chronic (long-lasting) illness that results is not clear. When diagnosed, acute HGV infection has usually been mild and brief. There is no evidence of serious complications, but it is possible that, like other hepatitis viruses, HGV can cause severe liver damage resulting in liver failure. The virus has been identified in as many as 20 percent of patients with long-lasting viral hepatitis, some of whom also have hepatitis C. DIAGNOSIS: The only method of detecting HGV is a complex and costly DNA test that is not widely available. Efforts are under way, however, to develop a test for the HGV antibody, which is formed in response to invasion by the virus. Once antibody is present, however, the virus itself generally has disappeared, making the test too late to be of use. TREATMENT: There is no specific treatment for any form of acute hepatitis. Patients should rest in bed as needed, avoid alcohol, and be sure to eat a balanced diet. PROGNOSIS: What little is known about the course of hepatitis G suggests that illness is mild and does not last long. When more patients have been followed up after the acute phase, it will become clear whether HGV can cause severe liver damage. PREVENTION: Since hepatitis G is a blood-borne infection, prevention relies on avoiding any possible contact with contaminated blood. Drug users should not share needles, syringes, or other equipment.

NON-VIRAL & TOXIC HEPATITIS

TOXIC HEPATITIS OVERVIEW

TOXIC HEPATITIS In addition to the various types of viral hepatitis, there is a form of the disease called toxic hepatitis, which can be caused by exposure to chemicals, principally the injection, ingestion, or absorption of toxins through the skin. Environmental toxins such as chlorinated hydrocarbons [e.g. carbon tetrachloride], Amanita phalloides toxin, or arsenic are examples of toxic agents.

It is also possible to develop toxic hepatitis, not only as a result of environmental toxins, but as a result of alcohol or drug use, including the overuse of over-the-counter medications such as acetaminophen or ibuprofen.

The amount of exposure to the toxin determines the extent of liver damage.

ALCOHOLIC HEPATITIS: Ethanol, mostly in alcoholic beverages, is a significant cause of hepatitis. Usually alcoholic hepatitis comes after a period of increased alcohol consumption. Alcoholic hepatitis is characterized by a variable constellation of symptoms, which may include feeling unwell, enlargement of the liver, development of fluid in the abdomen ascites, and modest elevation of liver blood tests. Alcoholic hepatitis can vary from mild with only liver test elevation to severe liver inflammation with development of jaundice, prolonged prothrombin time, and liver failure. Severe cases are characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin levels and prolonged prothrombin time; the mortality rate in both categories is 50 percent within 30 days of onset. Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption. Alcoholic hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis. Alcoholic hepatitis by itself does not lead to cirrhosis, but cirrhosis is more common in patients with long term alcohol consumption. Patients who drink alcohol to excess are also more often than others found to have hepatitis C. The combination of hepatitis C and alcohol consumption accelerates the development of cirrhosis. DRUG INDUCED HEPATOTOXICITY: A large number of drugs can cause hepatitis: Agomelatine (antidepressant). Allopurinol. Amitriptyline (antidepressant). Amiodarone (antiarrhythmic). Atomoxetine. Azathioprine. Halothane (a specific type of anesthetic gas). Hormonal contraceptives. Ibuprofen and indomethacin (NSAIDs). Isoniazid (INH), rifampicin, and pyrazinamide (tuberculosis-specific antibiotics). Ketoconazole (antifungal). Loratadine (antihistamine). Methotrexate (immune suppressant). Methyldopa (antihypertensive). Minocycline (tetracycline antibiotic). Nifedipine (antihypertensive). Nitrofurantoin (antibiotic). Paracetamol (acetaminophen in the United States) can cause hepatitis when taken in an overdose. The severity of liver damage may be limited by prompt administration of acetylcysteine. Phenytoin and valproic acid (antiepileptics). Troglitazone (antidiabetic, withdrawn in 2000 for causing hepatitis). Zidovudine (antiretroviral i.e., against HIV). Some herbs and nutritional supplements. The clinical course of drug-induced hepatitis is quite variable, depending on the drug and the patient's tendency to react to the drug. For example, halothane hepatitis can range from mild to fatal as can INH-induced hepatitis. Hormonal contraception can cause structural changes in the liver. Amiodarone hepatitis can be untreatable since the long half life of the drug (up to 60 days) means that there is no effective way to stop exposure to the drug. Statins can cause elevations of liver function blood tests normally without indicating an underlying hepatitis. Lastly, human variability is such that any drug can be a cause of hepatitis. OTHER HEPATIC TOXINS: Other Toxins can cause hepatitis: Amatoxin-containing mushrooms, including the Death Cap (Amanita phalloides), the Destroying Angel (Amanita ocreata), and some species of Galerina. A portion of a single mushroom can be enough to be lethal (10 mg or less of a-amanitin). White phosphorus, an industrial toxin and war chemical. Carbon tetrachloride ("tetra", a dry cleaning agent), chloroform, and trichloroethylene, all chlorinated hydrocarbons, cause steatohepatitis (hepatitis with fatty liver). Cylindrospermopsin, a toxin from the cyanobacterium Cylindrospermopsis raciborskii and other cyanobacteria. METABOLIC DISORDERS: Some metabolic disorders cause different forms of hepatitis. Hemochromatosis (due to iron accumulation) and Wilson's disease (copper accumulation) can cause liver inflammation and necrosis. non-alcoholic steatohepatitis (NASH) is effectively a consequence of metabolic syndrome. OBSTRUCTIVE: "Obstructive jaundice" is the term used to describe jaundice due to obstruction of the bile duct (by gallstones or external obstruction by cancer). If longstanding, it leads to destruction and inflammation of liver tissue. AUTOIMMUNE HEPATITIS: Anomalous presentation of human leukocyte antigen (HLA) class II on the surface of hepatocytes, possibly due to genetic predisposition or acute liver infection; causes a cell-mediated immune response against the body's own liver, resulting in autoimmune hepatitis. ALPHA 1-ANTITRYPSIN DEFICIENCY: In severe cases of alpha 1-antitrypsin deficiency (A1AD), the accumulated protein in the endoplasmic reticulum causes liver cell damage and inflammation. NON-ALCOHOLIC FATTY LIVER DISEASE: Non-alcoholic fatty liver disease (NAFLD) is the occurrence of fatty liver in people who have no history of alcohol use. It is most commonly associated with obesity (80 percent of all obese people have fatty liver). It is more common in women. Severe NAFLD leads to inflammation, a state referred to as non-alcoholic steatohepatitis (NASH), which on biopsy of the liver resembles alcoholic hepatitis (with fat droplets and inflammatory cells, but usually no Mallory bodies). The diagnosis depends on medical history, physical exam, blood tests, radiological imaging and sometimes a liver biopsy. The initial evaluation to identify the presence of fatty infiltration of the liver is medical imaging, including such ultrasound, computed tomography (CT), or magnetic resonance (MRI). However, imaging cannot readily identify inflammation in the liver. Therefore, the differentiation between steatosis and NASH often requires a liver biopsy. It can also be difficult to distinguish NASH from alcoholic hepatitis when the patient has a history of alcohol consumption. Sometimes in such cases a trial of abstinence from alcohol along with follow-up blood tests and a repeated liver biopsy are required. NASH is becoming recognized as the most important cause of liver disease second only to hepatitis C in numbers of patients going on to cirrhosis. ISCHEMIC HEPATITIS: Ischemic hepatitis is caused by decreased circulation to the liver cells. Usually this is due to decreased blood pressure (or shock), leading to the equivalent term "shock liver". Patients with ischemic hepatitis are usually very ill due to the underlying cause of shock. Rarely, ischemic hepatitis can be caused by local problems with the blood vessels that supply oxygen to the liver (such as thrombosis, or clotting of the hepatic artery which partially supplies blood to liver cells). Blood testing of a person with ischemic hepatitis will show very high levels of transaminase enzymes (AST and ALT), which may exceed 1000 U/L. The elevation in these blood tests is usually transient (lasting 7 to 10 days). It is rare that liver function will be affected by ischemic hepatitis.

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FREQUENT SIGNS & SYMPTOMS

GENERAL EARLY SYMPTOMS:

Flu-like symptoms, such as fever, fatigue, muscle aches, nausea, vomiting, diarrhea, and loss of appetite. Weakness, abdominal pain, and headaches also are common symptoms.

Elevated enzymes in the blood.

LATER SYMPTOMS SEVERAL DAYS LATER:

Jaundice (yellow eyes and skin) caused by a build-up of bile in the blood.

Dark urine from bile spilling over into the urine.

Light, "clay-colored" or whitish stools.

Itching and impaired mental state.

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CAUSES

See Types of Hepatitis above for a more detailed description.

VIRAL CAUSES

Types A and E: The virus usually enters the body through water or food, especially raw shellfish, that has been contaminated by sewage (fecal-oral contact).

Type B: Usually sexually transmitted (contact with bodily fluids or an infected person), through blood transfusions contaminated with the virus, or from injections with non-sterile needles or syringes. An infected mother can pass it to her newborn. Some cases appear sporadically.

Type C: Usually transmitted through intravenous drug use, blood transfusions, and other exposures from contaminated blood or its products. An infected mother usually does not pass it on to her newborn. This is a rare occurrence. In 40% of the cases, mode of transmission is unknown.

Type D: Associated with an infection of hepatitis type B.

Type G: Similar patterns to type C; usually blood-borne.

NON-VIRAL CAUSES

Hepatitis can also be caused by alcohol, drug and toxin abuse, or by an autoimmune process that produces antibodies that attack the liver.

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RISK INCREASES WITH

Travel to areas with poor sanitation.

Oral-anal sexual practices

Use of intravenous drugs.

Alcoholism.

Blood transfusions.

Health care workers and other occupational risks.

Day-care centers or residential programs.

Kidney-dialysis treatment.

Poor nutrition.

Illness that has lowered resistance.

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PREVENTIVE MEASURES

Avoid risk factors listed above. Practice good hygiene and use common sense. Cook all food well, boil water that may be contaminated, wash hands often. If you travel abroad, or have children in a day-care facility, consider getting vaccinations (see link below about vaccinations).

Avoid exposure to the blood of anyone contaminated with the disease. Do not share razors, nail files, toothbrushes, or needles with anyone who has hepatitis. If you are exposed to someone with hepatitis, seek medical advice about whether or not you should receive gamma-globulin injections to prevent or decrease the risk of hepatitis.

If you require surgery and may need a blood transfusion, discuss this with your health care provider or surgeon. You may be able to bank your own blood or the blood of a relative or friend before the procedure.

If you are in a high-risk group, such as a hospital worker, dentist, dental worker, sexually promiscuous, intravenous drug abuser, and others, obtain information about hepatitis vaccinations (A and B available; others being studied) and immune globulin in addition to the vaccination.

• There is a vaccine available to protect against hepatitis A. It is recommended for members of high-risk groups such as those suffering from liver disease, those in contact with hepatitis A-infected people, those who engage in anal sex with multiple partners, and those traveling to areas where hepatitis A is common, including Africa, the Middle East, the Caribbean, and South and Central America. The U.s. centers for Disease Control (CDC) now recommends that children living in high-risk states in this country be vaccinated against the disease as well. The high-risk states included Arizona, Alaska, California, Idaho, New Mexico, Oregon, South Dakota, and Washington. Some other states have areas where hepatitis A is common. Ask your health care provider about possible side effects from the vaccine.



• There is a vaccine available that gives protection against hepatitis B for approximately 5 years. Ask your health care provider about both the benefits and side effects.



• Because the hepatitis C virus has many genotypes, or forms, and can mutate rapidly, no vaccine has yet been developed to successfully protect against this virus. Likewise, there are no vaccines against hepatitis D or E.



• It has been a common medical practice in Massachusetts hospitals to provide routine hepatitis B vaccinations for all newborn infants in the event that the mother is a hepatitis B carrier. However there has been a great deal of controversy over this practice lately due to Thimerosal (a mercury based preservative found in vaccines and other products). In Massachusetts, the State Department of Health has urged hospitals to temporarily halt routine vaccinations for newborns against hepatitis B. Associated Press, 07/23/99 As a parent you have a choice of vaccination or non-vaccination of your children under certain conditions. See pros and cons of vaccinations for more information.

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EXPECTED OUTCOME

Jaundice and other symptoms peak and then gradually disappear over 3 to 16 weeks. Most people in good general health recover fully in 1 to 4 months. A small percentage proceed to chronic hepatitis. Recovery from viral hepatitis usually provides permanent immunity against it.

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POSSIBLE COMPLICATIONS

Liver failure, cirrhosis of the liver, liver cancer, even death. Some individuals may qualify for liver transplant surgery. Consult with your health care provider about options open to you if you are dealing with liver failure.

Chronic hepatitis. These patients are carriers and potentially infectious to household and sexual contacts. These people may look and feel well and not realize they are infected.

TREATMENT

GENERAL MEASURES

Diagnostic tests include laboratory blood tests to identify infection, liver function studies and liver biopsy in severe or chronic cases. If you have already been diagnosed with viral hepatitis, you may be monitored for viral counts (number of viral organisms in your blood) using various tests such as PCR amplification and detection, b-DNA tests for viral count and monitoring, genotyping of viral hepatitis (some strains of virus respond to therapy and other strains are resistant to therapy). PCR amplification HCV BDNA testing can also be used to test for virus in the blood and body organs as well as to monitor therapy treatment. (I used to do this type of testing for Hepatitis C for many years at a local Boston hospital.)

Hepatitis is diagnosed by means of a blood test. In some cases, it may be necessary to double-check a test for the hepatitis C virus by means of a test called the RIBA HCV 3.0 Strip Immunoblot Assay (SIA).

A home test called the Home Access Hepatitis C Check is available. It can be purchased in drugstores or ordered directly from the manufacturer, Ab Diagnostics.

HOME CARE

Most persons with hepatitis can be cared for at home without undue risk. Strict isolation is not necessary, depending on the cause and type of hepatitis, but the ill person should have separate eating and drinking utensils, or use disposable ones. A person with Hepatitis A should be kept in isolation to avoid spreading the infection.

If you have hepatitis or are caring for someone with it, wash your hands carefully and often, especially after bowel movements. Wash clothing often. The clothing of a person with hepatitis A require special handling. Wash them separately from other laundry in hot water with chlorine bleach or a disinfectant added. Because feces are infectious, bathrooms should be decontaminated frequently. Clean toilets and floors with disinfectant or a 10 percent bleach solution (9 parts water to 1 part bleach).

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MEDICATION

There are few specific medications to treat hepatitis.

• Chronic hepatitis B or C may be treated with alpha-interferon. Ribovirin (Virazole) and interferon may be prescribed for hepatitis C and are proving to be effective in the treatment of this disease.



• Adefovir dipivoxil (Hepsera) tablets slow the progression of chronic hepatitis B by blocking an enzyme needed for the virus to reproduce within the body.



• An anti-inflammatory (cortisone) may be prescribed for severe cases to reduce liver inflammation and improve symptoms.



• A study reported in the New England Journal of Medicine indicated that high doses of the antiviral agent interferon alfa, given daily for four months, produced remission in a third of subjects with hepatitis B. People who had low levels of virus particles present in their bloodstreams benefited most. A version of interferon alfa (interferon alfa-2b) has been approved by the FDA for the treatment of hepatitis C.

WARNING! Drugs used in the treatment of viral hepatitis may have several negative side effects. Be sure to discuss them with your health care provider before taking them. There are no drugs that have been proven absolutely safe for your developing baby. Use extreme caution in taking any medications during pregnancy and then these should only be used after all other methods have been tried and with the careful guidance of your midwife or health care provider.

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ACTIVITY

Bed rest is recommended until jaundice disappears and appetite returns. People differ widely in the rate at which they can return to normal activity. Drugs used in the treatment of hepatitis may have some negative side effects that may alter your normal daily routine.

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HERBAL & HOLISTIC RECOMMENDATIONS

LIFESTYLE RECOMMENDATIONS

Get plenty of rest.

Apply warm castor oil packs over the liver area. Place castor oil in a pan and heat but do not boil it. Dip a piece of cheesecloth or other white cotton material in the oil until the cloth is saturated. Apply the cloth to the upper right abdomen and cover it with a piece of plastic that is larger in size than the cotton cloth. Place a heating pad over the plastic and use it to keep the pack warm. Keep the pack in place for one-half to two hours, as needed.

Keep a person with hepatitis A in isolation to avoid spreading the infection. Wash hands and all clothing often. The clothing and bed linens of a person with hepatitis A require special handling. Wash them separately from other laundry in hot water with chlorine bleach or a disinfectant added. Because the feces are infectious, bathrooms should be decontaminated frequently. Clean toilets and floors with a disinfectant.

Especially when traveling, beware of contaminated water or foods from polluted waters.

Do not take any drugs that have not been prescribed by your health care provider. Read package inserts carefully for information regarding liver toxicity.

CONSIDERATIONS

One of the most important forms of hepatitis worldwide - hepatitis E - is rarely seen in the United States, but it has been linked to numerous large epidemics in Africa and Asia. Two outbreaks in Mexico in 1986 were the first to be identified in the Western Hemisphere. Sporadic cases have occurred among travelers, including some Americans. Hepatitis E is usually contracted from sewage-contaminated water, and it can be spread from person to person. It is more likely to cause symptoms in adults than in small children. No blood test is available, but the virus can be identified through a stool sample. The best known safeguard is to boil water before drinking it or washing with it.

Taking excessive amounts of vitamin A over long periods may cause liver enzyme levels to become elevated. Anyone who has been taking over 50,000 IU of vitamin A daily for over a year should reduce their intake or switch to an emulsion form, which is less harmful to the liver and/or natural beta-carotene, which should not have any side effects.

If you have hepatitis C, it is best to reduce the iron levels in the body before starting any treatment. High iron levels inhibit therapy for the liver.

Catechin, a flavonoid found in green and black Indian teas, has been shown to decrease serum bilirubin levels in people with all types of acute viral hepatitis.

Liver extract supplements contain nutritional substances that aid liver regeneration. Only products derived from organically raised beef should be use.

In laboratory experiments, injections of whole liver cells have rapidly repaired liver tissue in experimental animals with lethal, acute liver failure.

According to researchers at the University of California, as many as 25 percent of Americans who receive blood transfusions develop hepatitis. If you are planning on having any surgery where you may need to receive blood as part of the treatment, you should consider donating and storing your own blood ahead of time to be used for your transfusion instead of relying upon the standard anonymous donations that are usually stored at your hospital blood bank.

Silymarin, the active ingredient in Milk Thistle, has been known to lower liver enzymes and reverse the kind of liver damage common in people with hepatitis C. Some studies have shown that the herb Milk Thistle can cure liver cancer in rats. See herbs below for more information and supplements.

Ultraviolet blood irradiation therapy (UBIT) is said to improve the oxygenation of tissue, help with inflammation, stimulate the immune system, and fight viral infection. This treatment consists of bombarding the blood with ultraviolet light. It appears to render the virus inactive.

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HEPATITIS DIET & NUTRITIONAL RECOMMENDATIONS

Despite poor appetite, small well-balanced meals help promote recovery. Eat a raw vegetable and fruit diet for two to four weeks. Start this diet with a cleansing fast.

MoonDragon's Health Therapy: Cleansing Fasting Program

Include artichokes in the diet. Artichokes protect the liver. Globe artichoke extract also is available.

Herbal Remedies: Artichoke Extract, Standardized, Nature's Way, 300 mg, 60 Caps

Herbal Remedies: Artichoke Leaf Tincture, 2 fl. oz.

Herbal Remedies: Artichoke Herb Powder (Cynara Scolymus), 4 oz. Bulk

Drink "green drinks", carrot juice, and beet juice.

MoonDragon's Health Therapy: Juicing

Herbal Remedies: Beet Root, Nature's Way, 500 mg, 100 Caps

Herbal Remedies: Green Phyto Foods, Vegetarian Powder, NOW Foods, 10 oz.
Green Phyto Foods is a potent vegetarian blend of 30 nutrient dense superfoods containing a variety of vitamins, minerals, fiber, chlorophyll, enzymes and herbs.

Herbal Remedies: Green Phyto Foods, NOW Foods, 1000 mg, 90 Tabs
These green foods naturally contain high concentrations of chlorophyll and are harvested seasonally to take advantage of high potencies of naturally occurring nutrients. Everyone should consume green superfoods daily.

Herbal Remedies: ProGreens Powder With Advanced Probiotic, Allergy Research Group / Nutricology, 9.3 oz.
ProGreens is an all-natural blended variety of "Super Foods" that provide broad-spectrum nutritional support from certified organic grasses and natural food factors not found in isolated vitamins or mineral concentrates.

Drink only steam distilled or quality pure water. At least 8 glasses of water are necessary each day.

Consume no alcohol in any form. Propylene glycol is a compound related to alcohol that is commonly used in medicines that are supposed to be alcohol-free. It too should be avoided..

Avoid all fats, sugar, and highly processed foods.

Avoid all raw fish and shellfish, and eat no animal protein. Also avoid chemicals and food additives.

Use chlorophyll-containing enemas such as fresh wheatgrass juice or Kyo-Green from Wakunaga, 3 times per week. Use one pint and retain it for 15 minutes.

Herbal Remedies: Kyo Green Barley Grass Supplement, Powdered Drink Mix, Energy, Vegetarian, Kyolic, 10 oz.

Herbal Remedies: Wheat Grass Powder, Organic, 8.5 oz.

Herbal Remedies: Barley Grass Powder, 100% Organic, Vegetarian, NOW Foods, 2 lbs.

MoonDragon's Health Therapy: Enemas

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HERBS

Artichoke increases the effectiveness of liver function.

Herbal Remedies: Artichoke Extract, Standardized, Nature's Way, 300 mg, 60 Caps

Herbal Remedies: Artichoke Leaf Tincture, 2 fl. oz.

Herbal Remedies: Artichoke Herb Powder (Cynara Scolymus), 4 oz. Bulk

Herbal Remedies: Daily Gentle Cleansing & Digestion, Irwin Naturals, 60 Liquid Softgels
For Liver and Bile Function, Milk Thistle, Dandelion and Artichoke all work together to support healthy liver function and fat digestion.

Herbal Remedies: Silymarin Milk Thistle, Artichoke & Dandelion Extract, NOW Foods, 300 mg, 50 VCaps

Ayurvedic medicine has used Beets to promote the regeneration of liver cells.

Herbal Remedies: Beet Root, Nature's Way, 500 mg, 100 Caps

Burdock and Dandelion are important for cleansing the liver and the blood stream.

Herbal Remedies: Burdock Root Powder (Arctium Lappa), 4 oz. Bulk

Herbal Remedies: Burdock Supplement Tincture, 2 fl. oz.

Herbal Remedies: Burdock Root, Nature's Way, 540 mg, 100 Caps

Herbal Remedies: Burdock Supplements & Products

Herbal Remedies: Dandelion Root Tincture, 100% Organic, 2 fl. oz.

Herbal Remedies: Dandelion Tea, NOW Foods, Organic, 30 Tea Bags

Herbal Remedies: Dandelion Root, Nature's Way, Vegetarian, 540 mg, 180 VCaps

Herbal Remedies: Dandelion Root Powder (Taraxacum Officinale), 4 oz. Bulk

Herbal Remedies: Dandelion Supplements & Products

Studies Have shown Licorice to be effective in treating viral hepatitis, particularly chronic active hepatitis, due to its well-documented antiviral activity. Caution: Do not use this herb on a daily basis for ore than 7 days in a row. Avoid it altogether if you have high blood pressure.

Herbal Remedies: Licorice Root Powder (Glycyrrhiza Glabra), 4 oz. Bulk

Herbal Remedies: Egyptian Licorice Tea, Yogi Tea, Certified Organic, 16 Tea Bags

Herbal Remedies: Licorice Extract Tincture, Herbal Remedies USA, 2 fl. oz.

Herbal Remedies: De-Glycyrrhizinated Licorice (DGL) Extract, NOW Foods, 400 mg, 100 Lozenges

Herbal Remedies: Licorice Supplements & Products

Ligustrum is a good immune restorative and anti-inflammatory agent.

Herbal Remedies: Ligustrum Lucidum / Glossy Privet Supplements & Products

Herbal Remedies: Ligustrum Sinense / Chinese Privet Supplements & Products

Herbal Remedies: Ligustrum Vulgare / Common Privet Supplements & Products

Milk Thistle extract contains silymarin, a flavonoid that has been shown to aid in healing and rebuilding the liver. It can be taken in capsule form or alcohol-free extract form. Take 200 to 400 milligrams 3 times daily.

Herbal Remedies: Silymarin Milk Thistle Extract, With Artichoke & Dandelion Extract, NOW Foods, 300 mg, 50 VCaps

Herbal Remedies: Thisilyn, Milk Thistle Extract, Vegetarian, Nature's Way, 175 mg, 100 VCaps

Herbal Remedies: Milk Thistle Extract, Standardized, Nature's Way, 175 mg, 60 VCaps

Herbal Remedies: Milk Thistle Seed Powder (Silybum Marianum), 4 oz. Bulk

Herbal Remedies: Milk Thistle Seed Tincture, 100% Organic, 2 fl. oz.

Herbal Remedies: Super Thisilyn Advanced Detox Formula, Nature's Way, 100% Natural, 60 VCaps

Herbal Remedies: AlcohLiver Fix, Yangan, 60 Caps
AlcohLiver Fix is made of extracts from schisandra, white peony, and milk thistle, this well-known formula is used in traditional Chinese medicine for its liver nurturing and restoring, detoxifying, virus inhibiting properties to maintain healthy liver and its functions, Chinese herbs for liver support.

Herbal Remedies: Detox Support, NOW Foods, 90 Caps
NOW Detox Support is a comprehensive fusion of vitamins, minerals and herbs scientifically formulated to rid the body of energy depleting chemicals, pollutants and toxins. With an impressive complex of herbs, including Milk Thistle, NOW Detox Support is like an invigorating shower for your vital systems!

Herbal Remedies: Milk Thistle Supplements & Products

Olive Leaf extract is a potent antifungal agent. Olive Leaf extract eases inflammation and is good for any bacterial infection.

Herbal Remedies: Olive Leaf Extract, Standardized, Nature's Way, 500 mg, 60 Caps
Nature's Way Standardized Olive Leaf extract is a technically advanced herbal product. Standardization assures specific measurable levels of important compounds that provide beneficial activity in the body. Olive leaf extract standardized to 12% oleuropin. Scientifically & technically advanced premium extract. Olive Leaf (Olea europaea) herb has long been used for general well being and has been the focus of research since the 1800's. Oleuropin the bitter glycoside found in the leaves has been identified as a key constituent which provides some of the therapeutic benefits of Olive Leaf. Recommendation: Take 1 capsule two times daily with food or water.

Phyllanthus, an Ayurvedic herb, is useful for hepatitis B. After and initial bout with the virus, you can become symptom-free but still remain a carrier of the disease. This herb is said to eradicate carrier-status hepatitis B in some cases.

Herbal Remedies: Phyllanthus Complex, Hypoallergenic, Allergy Research Group / Nutricology, 120 Caps
Phyllanthus amarus is an Indian herb that has been used for more than two thousand years by Ayurvedic practitioners for liver support. Dandelion root has been used world-wide in the support of liver and gallbladder function.

Schizandra is a Chinese herb used to protect the liver.

Herbal Remedies: Schizandra Fruit, 580 mg, 100 Caps

Herbal Remedies: Schizandra Berry Tincture, 2 fl. oz.

Herbal Remedies: Schizandra Supplements & Products

Scutellaria, also known as Baikal Skullcap or Chinese Skullcap, is a Chinese herb that is a powerful antioxidant.

Herbal Remedies: Skullcap Tincture, 100% Organic, Herbal Remedies USA, 2 fl. oz.

Herbal Remedies: Scullcap Herb, Nature's Way, 425 mg, 100 Caps

Herbal Remedies: Baical Skullcap Supplements & Products

Herbal Remedies: Skullcap / Scullcap Supplements & Products

Turmeric (Curcumin) is a potent anti-inflammatory and helps to reduce inflammation.

Herbal Remedies: Turmeric Extract (Curcuma Longa), Standardized To 95% Curcuminoids, Nature's Way, 500 mg, 120 Tabs

Herbal Remedies: Curcumin (Turmeric), NOW Foods, 665 mg, 60 VCaps

Herbal Remedies: Turmeric Powder, 4 oz. Bulk

Herbal Remedies: Turmeric Tincture, 100% Organic, 2 fl. oz.

Herbal Remedies: Turmeric Root Powder, Certified Organic, Banyan Botanicals, 1/2 lb.

Herbal Remedies: Turmeric Extract, Source Naturals, 50 Tabs

Herbal Remedies: Turmeric / Curcumin Supplements & Products

Fumitory has been shown to stimulate bile flow and strengthen the liver. Caution: Fumitory is toxic in large doses. Do not exceed recommended doses. Consult with your health care provider before using fumitory.

Herbal Remedies: Avea Mood, Liquid Extract, 30 ml

Other herbs beneficial for hepatitis include:

• Black Radish. The Black Radish is said to have a pronounced effect on the liver, activating and regenerating liver cells. It acts as a "cholagogue," or substance that stimulates the production of bile from the liver to the intestines, serving as a liver tonic and helping to purify it. This action also helps to cleanse and purify the blood and reduce gravel in the gallbladder.


Herbal Remedies: Enzymatic Therapy, Doctor's Choice, Multi-Vitamin For Women Age 45 Plus, 180 Tabs

Herbal Remedies: Enzymatic Therapy, Doctor's Choice, Multi-Vitamin For Men Age 50 Plus, 120 Tabs

Shaman Shop: Black Radish Root, 90 VCaps

Shaman Shop: Black Radish Root Powder, 1/4 lb.


• Green Tea. One capsule of NOW Green Tea Extract with 200mg EGCg possesses the phytonutrient content equal to about 2-3 cups of green tea. Green Tea Extract contains numerous compounds, including Polyphenols and Catechins, that provide potent antioxidant benefits. One Catechin in particular, EGCg, has demonstrated extraordinary free radical quenching power in laboratory studies. In non-clinical studies, EGCg has also been shown to be protective against chemical and environmental assault on tissues and helps to support healthy cell cycle regulation. Cautions: Due to the lack of any substantial amount of caffeine in this formula, most of the usual tea cautions are not applicable. While the mild anticoagulant effects will not normally affect most people to any great degree, some caution should be used if taking blood-thinning drugs. Green tea may help the effects of chemotherapy drugs while preventing the normal tissue damage from these drugs. Please notify your health care provider about your supplement use if you are using any drugs.


Herbal Remedies: EGCg Green Tea Extract, Vegetarian Formula, NOW Foods, 400 mg, 90 VCaps

Herbal Remedies: Simply Green Tea, Organic, Yogi Tea, 16 Bags

Herbal Remedies: Green Tea Extract Tincture, Herbal Remedies USA, 2 fl. oz.

Herbal Remedies: Green Tea Supplements & Products


• Red Clover. Since ancient times, Red Clover has been cultivated primarily to provide a grazing food for animals, but Chinese health care providers and Russian folk healers used it to treat respiratory problems. By the 19th century, Red Clover was used as a blood purifier. For centuries it was believed that many illnesses including cancer, eczema, and eruptions of the venereal disease, were caused by toxins in the blood. Red Clover has isoflavones that are similar but not identical to estrogen and have anti-tumor qualities.


Herbal Remedies: Red Clover Herb, Nature's Way, 500 mg, 100 Caps

Herbal Remedies: Red Clover Herb Powder (Trifolium Pratense), 4 oz. Bulk

Herbal Remedies: Red Clover Tincture, 100% Organic, 2 fl. oz.

Herbal Remedies: Red Clover Supplements & Products


• Yellow Dock. Yellow Dock is used in treating conditions of the blood and glandular system and is indicated in scrofula, eruptive diseases, especially when discharges are experienced, as in running of the ears, ulcerated eyelids and skin conditions, itch, scurvy, brittle nails, etc. This herb works in treating bowel infections, peptic ulcers and is stimulates the liver and bile production. It can also help improve digestion, and reduce flatulence and distension.


Herbal Remedies: Yellow Dock Root, 500 mg, 100 Caps

Herbal Remedies: Yellow Dock Supplement Tincture, 2 fl. oz.

Herbal Remedies: Gland Formula Liquid, 16 fl. oz.

Herbal Remedies: Liver Detox Formula Tincture, 100% Organic, Herbal Remedies USA, 2 fl. oz.

Herbal Remedies: Colon & Liver Cleanser, 16 fl. oz.

Herbal Remedies: Yellow Dock Supplements & Products

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NUTRITIONAL SUPPLEMENT RECOMMENDATIONS

The following nutrients are important for healing once appropriate local treatment has been administered. Unless otherwise specified, the following recommended doses are for those over the age of 18. For a child between 12 and 17 years old, reduce the dose to 3/4 the recommended amount. For a child between 6 and 12 years old, use 1/2 the recommended dose, and for a child under 6, use 1/4 the recommended amount.

NUTRIENTS
Supplement	Suggested Dosage	Comments
Essential
Alpha-Lipoic Acid (ALA)	As directed on label.	Has antioxidant properties that protect the liver. Alpha Lipoic Acid, NOW Foods, 250 mg, 60 Caps, Alpha Lipoic Acid With Rosemary, Nature's Way, Pharmaceutical Grade, 50 mg, 60 Caps
Beta-1,3-Glucan	As directed on label.	An excellent antioxidant. Boosts immune system function and fights inflammation. Stimulates the activity of macrophages, which surround and digest cellular debris. Barley Bran Supplement, Standardized 60% Beta-Glucan, Nature's Way, 60 VCaps, Oat Bran Extract, Standardized 54% Beta Glucan, Vegetarian, Nature's Way, 60 VCaps,
Free Form Amino Acid Complex	As directed on label.	To supply necessary protein. The liver breaks down protein; taking free form amino acids takes strain off the liver. Amino 1000 Complete, NOW Foods, 120 Caps, Amino 1500, Chewable Blend of 20 Amino Acids, Predigested, NOW Foods, 150 Tabs
Glutathione	500 mg twice daily, on an empty stomach.	Protects the liver. L-Glutathione, NOW Foods, 250 mg, 60 Caps, ThioDox Glutathione Complex, Hypoallergenic, Allergy Research Group / Nutricology, 90 Tabs
Plus L-Arginine	As directed on label.	Detoxifies the liver. L-Arginine, Pharmaceutical Grade, Vegetarian, NOW Foods, 1000 mg, 120 Tabs, AAKG 3500 Amino Acid Supplement, Vegetarian, NOW Foods, 180 Tabs, AAKG Powder (L-Arginine Alpha Ketoglutarate), 100% Pure, Vegetarian, NOW Foods, 3000 mg, 7 oz.
And L-Cysteine And L-Methionine	500 mg each twice daily, on an empty stomach. Take with water or juice. Do not take with milk. Take with 50 mg Vitamin B-6 and 100 mg Vitamin C for better absorption.	Detoxify harmful hepatotoxins and protects glutathione. See Amino Acids for more information. L-Cysteine Structural Support With Vitamin B-6 & C, Vegetarian, NOW Foods, 500 mg, 100 Tabs, NAC (N-Acetyl Cysteine), Selenium & Molybdenum, NOW Foods, 600 mg, 100 Caps, L-Methionine Plus B-6, NOW Foods, 500 mg / 10 mg, 100 Caps
Inositol Hexaphosphate (IP-6)	As directed on label.	A powerful antioxidant that has many positive effects on the body, including protecting the liver. Also known as phytic acid. Cell Forte Max3 IP-6 & Inositol Plus Maitake & Cat's Claw, Enzymatic Therapy, 120 UltraCaps, Inositol (Vitamin B-8), 100% Pure Crystalline, Nature's Way, 500 mg, 100 Caps
Liquid Kyolic With Vitamin B-1 & B-12	As directed on label.	A powerful antioxidant that has many positive effects on the body, including protecting the liver. Also known as phytic acid. Kyolic Liquid Aged Garlic Extract, Vegetarian, Wakunaga Kyolic, 4 fl. oz., Vitamin B-1 / Thiamin HCl, 100% Natural, 100 mg, 100 Caps, Ultra B-12, NOW Foods, 4 oz., Vitamin B-12 Complex Liquid, NOW Foods, 2 fl. oz.
Raw Liver Glandular Extract Desiccated Liver	As directed on label. As directed on label.	Promotes liver function. See Glandular Therapy for more information. Consider injections (under a health care provider's supervision).
S-Adenosylmethionine (SAM-e) Or Trimethylglycine (TMG)	As directed on label. As directed on label.	Promotes the health of the liver. Needed for conversion of harmful homocysteine into methionine, the basis for production of SAM-e. SAM-e, Enteric Coated, NOW Foods, 100 mg, 30 Tabs, SAM-e, With B Vitamin Cofactors, Vegetarian, Enteric Coated, NOW Foods, 200 mg, 60 Tabs, SAM-e, S-Adenosyl-L-Methionine, Source Naturals, 400 mg, 30 Tabs, TMG (Trimethylglycine) Powder, NOW Foods, 3.5 oz., Extra Strength TMG (Trimethylglycine), NOW Foods, 1000 mg, 100 Tabs,
Selenium Or Selenium Forte	200 mcg daily. If you are pregnant, do not exceed 40 mcg daily.	A powerful antioxidant and aid in inflammation reduction. Studies have shown selenium helps to protect against liver cancer. Caution: Do not take supplemental selenium if you are pregnant or have heart, kidney, or liver disease. Selenium Supplement, Yeast Free, NOW Foods, 200 mcg, 180 Caps, Selenium Ionic Mineral Supplement, Fully Absorbable, 50 +/- ppm, 16 fl. oz., Ionic Selenium, Trace Minerals, 300 mcg, 2 fl. oz., Selenium, 100% Natural, Nature's way, 200 mcg, 100 Caps
Very Important
Coenzyme Q-10	60 mg daily.	Counteracts immunosuppression and enhances tissue oxygenation. CoQ10, Vegetarian Coenzyme, NOW Foods, 30 mg, 60 VCaps, CoQ10, Now Foods, 400 mg, 60 Softgels
Coenzyme A	As directed on label.	Facilitates the repair of RNA and DNA. Supports the immune system's detoxification of many dangerous substances. Can streamline metabolism, ease depression and fatigue, and increase energy. Works well with CoQ10. Pantethine (Coenzyme A Precursor), Highly Active Form of Vitamin B-5, 300 mg, NOW Foods, 60 Softgels,
Dimethylglycine (DMG)	As directed on label.	Enhances and improves cellular oxygen concentration and utilization. DMG Supplement N,N Dimethyl Glycine, NOW Foods, 125 mg, 100 Caps
Lecithin Granules Or Capsules	1 tablespoon 3 times daily, before meals. 1,200 mg 3 times daily, with meals.	Protects cells of the liver and is a fat mobilizer. Aids in preventing fatty liver. Lecithin Vegetarian Granules, NOW Foods, 97% Phosphatides, Identity Preserved Non-GE, 1 lb, Lecithin Liquid, NOW Foods, Vegetarian, 16 fl. oz., Lecithin Concentrate, Nature's Way, 400 mg, 100 SoftGels
Multi-Vitamin & Multi-Mineral Complex	As directed on label.	All nutrients are needed in balance for healing and tissue repair. Essential for normal cell division and function. Super Multi-Vitamin & Multi-Mineral, Pure Vital Earth, 32 fl. oz. (98% Bio-Available for Absorption), Damage Control Master Formula, High Potency, Multi-Vitamin & Mineral, 60 Packets (30 Day Supply)
Vitamin B Complex	50-100 mg of each B vitamin daily, with meals 3 times daily (amounts of individual vitamins in a complex will vary). Do not exceed a total of 100 mg Vitamin B-3 (Niacin) in any one day until healing is complete.	B vitamins that improved circulation, build red blood cells, and aid liver function. Anti-stress vitamins, especially important for normal brain function. Needed for tissue repair. Sublingual forms are recommended. Injections (under a health care provider's supervision) may be necessary, especially of Vitamin B-12 and Folic Acid. Ultimate B (Vitamin B Complex), Nature's Secret, 60 Tabs, Vitamin B-100 Complex, w/ Coenzyme B-2, Nature's Way, 631 mg, 100 Caps
Vitamin B-12	1,000 mcg twice daily.	To prevent anemia and needed in tissue repair. Vitamin B-12 Complex Liquid, NOW Foods, 2 fl. oz., Vitamin B-12, Nature's Way, 2000 mcg, 100 Sublingual Lozenges, Vitamin B-12 Liquid Supplement, 50 mcg, With Vitamin B-9 (Folic Acid), 400 mcg, 1 oz. Vitamin B-12, California Natural, 1000 mcg, 60 Tabs, Vitamin B-12 LipoSpray, NOW Foods, 2 fl. oz.
Plus Choline And Inositol	500-1,000 mg daily.	Improves brain function and circulation to the brain. Use under professional supervision. Choline Supplement, 100% Natural, Nature's Way, 500 mg, 100 Tabs, Inositol (Vitamin B-8), 100% Pure Crystalline, Nature's Way, 500 mg, 100 Caps, Choline & Inositol, 100% Natural, Nature's Way, 250 mg / 250 mg, 100 Caps
Superoxide Dismutase (SOD)	As directed on label.	Powerful antioxidants that neutralize damaging free radicals, improving liver function. GliSODin Antioxidant Catalyst, NOW Foods, 100 mg, 90 VCaps,
Or Cell Guard	As directed on label.	Powerful antioxidants that neutralize damaging free radicals, improving liver function.
Or Oxy-5000 Forte	As directed on label.	Powerful antioxidants that neutralize damaging free radicals, improving liver function.
Vitamin C With Bioflavonoids	5,000-10,000 mg daily and up, in divided doses.	Essential to the healing process and in reducing inflammation. A powerful antiviral agent. Studies show improvement quickly with high doses. Vitamin C Liquid w/ Rose Hips & Bioflavonoids, Kosher, Natural Citrus Flavor, Dynamic Health, 1000 mg, 16 fl. oz., Ester C With Bioflavonoids, Nature's Way, 1000 mg, 90 Tabs, Vitamin C 1000 With Bioflavonoids, Nature's Way, 100% Natural, 1000 mg, 250 VCaps, The Right C, Nature's Way, 1000 mg, 120 Tabs
Vitamin E	200 IU daily or 400 IU every other day.	Effective antioxidant and reducer of inflammation. Use d-alpha-tocopherol form. Ester E Natural Vitamin E, California Natural, 400 IU, 60 Softgels, Vitamin E, 400 IU, 100% Natural, NOW Foods, 100 Gels, Vitamin E-1000, NOW Foods, 1000 IU, 100 Gels, Vitamin E, d-alpha-tocopherol, 400 IU, 100 Softgels
Important
Or Alfalfa	1,000-1,500 mg daily.	Contains a balance of essential minerals plus chlorophyll, which cleanses the blood. See more information under Herbs above. Alfa Max, Alfalfa Extract, Nature's Way, 525 mg, 100 Caps, Alfalfa Powder, Whole Food Supplement, NOW Foods, 1 lb., Alfalfa, NOW Foods, 650 mg, 500 Tabs, Alfalfa Tincture, 2 fl. oz., Chlorophyll With Alfalfa Powder, 100 mg, NOW Foods, 90 Caps
Calcium	1,500 mg daily.	Essential for normal cell division and function and blood clotting, which is a problem for people with liver disease. Use chelated forms. Do not use bone meal. Calcium Ionic Mineral Supplement, Fully Absorbable, 700 +/- ppm, 16 fl. oz., Liquid Calcium W/ConcenTrace, Orange Vanilla, Trace Minerals, 1000 mg, 32 fl. oz., Cal-Mag Pre-Chelated Calcium & Magnesium, Vital Earth, 240 Gelcaps
Magnesium	1,000 mg daily.	Essential for normal cell function and division. Helps uptake of calcium. Magnesium Ionic Mineral Supplement, Fully Absorbable, 350 +/- ppm, 16 fl. oz., Just An Ounce Calcium & Magnesium Liquid, Almond Flavor, 16 fl. oz., Calcium & Magnesium Mineral Complex, 100% Natural, Nature's Way, 500 mg / 250 mg, 250 Caps
Essential Fatty Acids	As directed on label.	A most important element in the diet supplying essential lipids. Necessary for a healthy immune system and to combat inflammation of the liver and lower serum fats. Speeds healing. Ultimate Oil, Essential Fatty Acids Supplement, Nature's Secret, 90 SoftGels, Barlean's Primrose Oil, With Gamma Linolenic Acid (GLA), 1300 mg, 120 SoftGels, Wild Salmon Oil, 2000 mg, 120 EPA/ 80 DHA, NOW Foods, 250 SoftGels Essential Fatty Acids For Baby & Children, Organic, 8 fl oz., Barlean's Flax Oil, 100% Highest Lignan Content, Organic, Pesticide & Herbicide Free, 16 fl. oz., Barlean's Flax Oil, Highest Lignan, 1000 mg, 250 Caps
Or Shark Liver Oil Or Squalene	As directed on label.	Important sources of essential lipids. To combat inflammation of the liver and lower serum fats. Shark Liver Oil, With Vitamin A, NOW Foods, 400 mg / 10,000 IU, 120 Softgels, NOW Foods, 750 mg, 100 Caps
Or Kyolic EPA	As directed on label.	Reduces triglyceride levels in the blood.
Grape Seed Extract	As directed on label.	Grape Seed Extract is one of the most potent antioxidants; protects the cells. Grape Seed (Grapeseed) (Vitus vinifera), 100% Pure, NOW Foods, 16 fl. oz.
Multi-Enzyme Complex With Betaine HCl	As directed on label. Take between meals and at bedtime, for 1 month.	Important for proper digestion. Powerful free radical scavengers. To aid in proper breakdown of proteins, fats, and carbohydrates for better absorption of nutrients. Aids in controlling inflammation. MetabolicZyme (Hypoallergenic), Allergy Research Group / Nutricology, 900 Tabs, Plant Enzymes, NOW Foods, Vegetarian, 120 VCaps, Enzymes, All Complete, 250 mg, 90 Caps, Betaine HCl, Digestive Supplement, NOW Foods, 120 Caps,
Or Inflazyme Forte (American Biologics)	2 tablets twice daily. Take between meals. Also available in powder form.	To aid in proper breakdown of proteins, fats, and carbohydrates for better absorption of nutrients. Aids in controlling inflammation.
Quercetin Plus Bromelain	Take combination as directed on label. If you take bromelain alone, Take on an empty stomach with 100-500 mg Magnesium and 500 mg L-Cysteine to enhance results. Take separately from copper and iron.	Quercetin helps to prevent reactions to certain foods, pollens, and other allergens. Increases Immunity. Bromelain enhances the effectiveness of quercetin. Bromelain has anti-inflammatory activity and increases the breakdown of fibrin, which forms around the inflamed area, blocking the blood and lymphatic vessels and leading to swelling. Quercetin With Bromelain, Hypoallergenic Bioflavonoid, NOW Foods, 800 mg, 120 VCaps, Bromelain 2000 GDU Supplement, NOW Foods, 500 mg, 90 Tabs
Garlic (Kyolic)	2 capsules 3 times daily, with meals.	Has natural anti-inflammatory properties. Garlic Oil Tincture, Alcohol Free, Nature's Way, 1 fl. oz., Garlic Bulb Cloves, Garlic Supplement, Nature's Way, 580 mg, 100 Caps, Odorless Garlic Supplement, NOW Foods, 50 mg, 250 SoftGels, Garlic Supplement, Kwai, Triple Concentrated, 180 Tabs, Every Day Garlic Supplement, Kwai, 30 Tabs, Garlic Tincture, 100% Organic, 2 fl. oz., Aged Garlic Extract, Cardiovascular Formula 100, Wakunaga Kyolic Supplements, 300 Caps, Kyolic Liquid Aged Garlic Extract, Cardiovascular, Vegetarian, Wakunaga Kyolic, 4 fl. oz., Kyolic Aged Garlic Extract, One-A-Day, Vegetarian, 1000 mg, Wakunaga Kyolic, 30 Caps, Aged Garlic Extract, Cholesterol Formula 104, Wakunaga Kyolic, 200 Caps
Kelp	1,000-1,500 mg daily.	Contains a balance of essential minerals plus chlorophyll, which cleanses the blood. Kelp Supplement, Nature's Way, Certified, 650 mg, 100 Caps, Kelp Seaweed, Norwegian, NOW Foods, 100% Natural, 550 mg, 250 Caps, Kelp Seaweed, Norwegian Powder, 4 oz. Bulk
Zinc	50 mg daily. Do not exceed a total of 100 mg daily from all supplements.	Helps to control inflammation and promotes healing. Use zinc gluconate lozenges or zinc methionate (OptiZinc) for best absorption. Zinc Ionic Mineral Supplement, Fully Absorbable, 100 +/- ppm, 16 fl. oz., Colloidal Silver & Zinc Lozenges, Silva Solution, 90 Lozenges, Zinc Lozenges W/ Echinacea & Vitamin C, Nature's Way, 23 mg, 60 Lozenges, Zinc (Chelated), 100% Natural, Nature's Way, 30 mg, 100 Caps
Helpful
Maitake Or Shiitake Or Reishi	As directed on label. As directed on label. As directed on label.	To boost the immune system and fight viral infection. Maitake mushroom extract that contains D-fraction form of isolated beta-1,6-glucan, a substance that prevents carcinogenesis and inhibits the growth of cancerous tumors. Also helps the body adapt to the stress of cancer treatments such as chemotherapy. Shiitake/Reishi mushroom extracts with valuable immune-boosting and anti-tumor properties. Mushrooms that build immunity and fight viral infections, inflammation and cancer. Mushroom Master 3 Mushroom Tincture, Red Reishi, Shiitake & Maitake Mushroom Extracts, Herbal Remedies USA, 2 fl. oz., Reishi Mushroom, Whole, 100% Organic, 4 oz., Shiitake Mushroom, Whole, 100% Organic, 4 oz., Maitake Mushroom, Whole, 100% Organic, 4 oz.
Raw Pancreas Glandular	As directed on label.	Aids in digestion and pancreatic function. See Gland Therapy. Pancreas (Beef), Organic Glandular (Hypoallergenic), Allergy Research Group/Nutricology, 90 Caps
Raw Thymus Glandular	As directed on label.	Improves Thymus function. Important for immune function. See Gland Therapy. Thymus Organic Glandular (Hypoallergenic), Allergy Research Group/Nutricology, 75 Caps
7-Keto-DHEA	As directed on label.	Increases antibody and interleukin-2 formation. A metabolite of DHEA that possesses anti-cancer properties without being converted into testosterone or estrogens. 7-Keto DHEA, Metabolite of DHEA, NOW Foods, 25 mg, 90 Caps
Vitamin A	10,000 IU daily. If you are pregnant, do not exceed 10,000 IU daily.	Needed for tissue repair and proper immune function. People with cancer require higher than normal amounts of this antioxidant. Use emulsion form for easier assimilation and greater safety at higher doses. Capsule forms put more stress on the liver. Avoid using beta carotene or capsule forms of vitamin A until healing is complete. Vitamin A, 10,000 IU, 100% Natural, Nature's Way, 100 Softgels
Plus Natural Beta-Carotene In With Carotenoid Complex	As directed on label.	Powerful antioxidants, free radical scavengers, and immune enhancers (strengthens the immune response). Beta Carotene (Natural Dunaliella Salina), Nature's Way, 100% Natural, 25,000 IU, 100 Softgels, Multi-Carotene Antioxidant, Nature's Way, 60 Softgels
AE Mulsion Forte (Biotics)	As directed on label.	Vitamin A is essential for tissue repair; vitamin E improves circulation. Both enhance immune function. Use this emulsion form for easier assimilation and safety at higher doses.
Or Micellized Vitamin A Emulsion (American Biologics)	25,000 IU daily. If you are pregnant, do not exceed 10,000 IU daily.	Needed for healing. Supplies vitamins A and E in easily assimilable emulsion form to destroy free radicals, boost the immune system, and help the body to use oxygen efficiently.

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HEPATITIS SUPPLEMENTAL PRODUCTS

Information, supplements and products for hepatitis, a general term that refers to a group of viruses that cause inflammation of the liver.

AlcohLiver Fix, Yangan, 60 Capsules AlcohLiver Fix is made of extracts from schisandra, white peony, and milk thistle, this well-known formula is used in traditional Chinese medicine for its liver nurturing and restoring, detoxifying, virus inhibiting properties to maintain healthy liver and its functions, Chinese herbs for liver support.

Alive! Whole Food Energizer Multi-Vitamin with Mineral, Nature's Way, 18 mg of Iron added, 90 Tabs Alive Whole Food Energizer Multi-Vitamin with Mineral with Iron by Nature's Way is absorbed into your blood stream 5 times faster than other leading brands.

Alpha Lipoic Acid w/ Rosemary, Nature's Way Pharmaceutical Grade, 50 mg, 60 Caps Alpha Lipoic Acid is central to recycling other antioxidants like Vitamin E, Vitamin C, and GSH glutathione. By "sparing" their destruction, Alpha Lipoate extends their antioxidant power. Being both water and fat soluble, lipoic acid is the "universal" antioxidant that can easily function in both cellular membranes and fluid media within and outside the cell.

Artichoke Herb Powder, 4 oz. Bulk Artichoke herb is an antioxidant, hepatic, and blood cleanser.

Artichoke, Standardized Extract, Nature's Way, 300 mg, 60 Caps Research on standardized Artichoke extract has focused on the constituent, caffeoylquinic acid and its ability to increase bile production in the liver. An increase in bile production assists the body in blood fat metabolism, which assists the digestion process. It is also an herbal remedy for gas (flatulence).

Astragalus Root Tincture, 100% Organic, 2 fl. oz. Astragalus root is used to stimulate the immune system and astragalus root improves adrenal gland function and digestion.

Black Seed Theramune Ultimate with Garlic, 100 Caps Promotes healthy circulation, useful for arthritis and cardiovascular & respiratory support. It also supports digestion and is a natural remedy for ulcers. Garlic is known to lower cholesterol naturally.

Blood Circulator, 100% Natural, Jingui Huayu, 450 mg, 60 Caps This time-honored formula is used in Chinese medicine to promote micro-circulation, increase blood flow to heart muscles, open and clear arteries, inhibit intestinal adhesion, soothe the liver, remove stasis and maintain healthy blood circulation and regular menses.

Bringraj Leaf Powder, Certified 100% Organic, Banyan Botanicals 1/2 lb. Bringraj is believed to prevent aging, maintains and rejuvenates hair, teeth, bones, memory, sight, and hearing.

Burdock Supplements and Products Helpful liver detoxifier.

Colon & Liver Cleanser, Truman's CAC Tea, Loose Leaf, 1/2 lb. Use of this cleansing tea has many additional benefits: improves overall digestion; strengthens the immunity; helps to prevent cancer; makes the skin more emollient and flexible: clears the eyes; and provides an overall tonic effect on the body.

Dandelion Root, Nature's Way, 540 mg, 180 VCaps Dandelion root has a long history of use as an herbal remedy, as a food, and in beverages. Dandelion root is native to Greece.

DMG Supplement N,N-Dimethyl-Glycine, NOW Foods, 125 mg, 100 Caps NOW Foods' DMG Supplement is a methylated amino acid found in all cells. DMG is an antioxidant and methyl donor that has a number of beneficial effects. It has shown to have potential in increasing immune response to the flu and salmonella.

Dr. Clark Liver & Gallbladder Cleanse Kit Dr. Clark Liver & Gallbladder Cleanse Kit includes Liver Support Tea (Bags 6 x 1/2 Cup), Epsom Salt (10 oz.), Ornithine (500 mg, 50 count), Freeze Dried Black, Walnut Hull (360 mg, 10 count), Citric Acid (2 tablespoons), and Vitamin C (1 tablespoon).

Enzyme PhytoNutrient (EPN) Ionic Supplement, Fully Absorbable, 16 fl. oz. WaterOz Ionic EPN is a pure liquid enzyme supplement. EPN complex is a patent-pending enzyme phytonutrient from a plant source that provides enzyme and saccharides necessary for optimal cellular communication.

Eye Sight Formula, TCM Formula, Jiju Dihuang, 100% Natural, 60 Caps The Eye Site Chinese herb formula is made of extracts from wolfberry, chrysanthemum flower, prepared rehmannia root, dogwood fruit, moutan bark root, common yam, poria and alisma, this time-honored formula is used in Chinese medicine for its immune supporting, and other properties to nourish the liver and kidney and to maintain healthy eyesight.

Food Grade Diatomaceous Earth (DE) Powder, 8 oz. This Food Grade Diatomaceous Earth is safe and nontoxic and destroys intestinal parasites physically by injuring them.

Get Clean Herb Tea For Detoxing No. 7, The Republic Of Tea, 36 Tea Bags This gentle naturally caffeine-free Get Clean Tea from Republic of Tea helps the body help itself as it stimulates the liver, one of our natural cleansing mechanisms.

Gotu Kola Powder, 4 oz. Bulk Gotu kola has been used as a tonic for purification of blood and for promoting healthy skin. It has also been used to aid in restful sleep, treat skin inflammations, as a treatment for high blood pressure and as a mild diuretic.

Herbs For Hepatitis C and the Liver, By Stephen Harrod Buhner Includes descriptions of common medical tests and treatments, a guide to knowing and using the top herbal medicines that work to protect the liver and immune system.

Hoxy Formula Tincture, 2 fl. oz. The Hoxy Formula can be used to help dissolve tumors.

L-Glutamine, Amino Acid Supplement, NOW Foods, 1000 mg, 120 Caps L-Glutamine is an important amino acid that helps brain function, as it converts quickly into glucose, the only source of energy to the brain. L-Glutamine promotes better thinking ability, and increases the amount of GABA, another amino acid that aids in proper brain function.

Licorice Root Powder (Glycyrrhiza Glabra), 4 oz. Bulk Licorice Root (Glycyrrhiza glabra) is famous for its delicious distinctive flavor, licorice is essential in innumerable candy, confection and beverage recipes and makes an estimable liqueur.

Liver Detoxifier & Regenerator, NOW Foods, 90 Caps Dr. Verghese's Liver Detoxifier & Regenerator is a proprietary blend of herbs and nutrients designed to support healthy liver function.

Liver Detox Formula Tincture, 100% Organic, Herbal Remedies USA, 2 fl. oz. The Liver Formula can be used to help treat alcoholism naturally.

Liver Rejuvenate, Liver Supplement, Vegetarian, Life-Flo, 90 Caps To maintain optimum liver health, the natural choice is Rejuvenate Liver Supplement from Life-Flo.

Milk Thistle Seed Powder (Silybum Marianum), 4 oz. Bulk Milk thistle extract is most commonly recommended to counteract the harmful actions of alcohol on the liver.

Milk Thistle Seed Tincture, 100% Organic, 2 fl. oz. After medical research on the medicinal effects of Milk Thistle Seed, Germany's Commission E approved an oral extract of Milk Thistle as a treatment for liver disease which includes alcoholic hepatitis, fatty liver, mild liver cirrhosis, liver poisoning and acute viral hepatitis.

Momordica Tincture, 2 fl. oz. It has been suggested that Bitter Melon, Momordica, has anti-tumor and antiviral actions. MAP 30 is a protein found in Bitter Melon that is believed to have multiple functions that could be beneficial in treating HIV infection.

Natural Therapy For Your Liver, Herbs and Other Natural Remedies For A Healthy Liver, Revised Edition, By Christopher Hobbs Hobbs details clinically tested herbal remedies for a variety of liver-related ailments, from hepatitis C and cirrhosis to acne and PMS; therapeutic liver flushes, cleanses and other natural methods for maintaining liver health.

Olive Leaf Extract Standardized, Nature's Way, 500 mg, 60 Caps Nature's Way Standardized Olive Leaf extract is a technically advanced herbal product.

Olive Leaf Plus, Black Seed with Olive Leaf Extract and High Potency Garlic, 100 Caps Combined, these herbs are a superior circulation and immune system support.

Reishi Liver Guard Herbal Tea, 20 Tea Bags Reishi Tea is an excellent tonic for liver and lung, vitality and immunity support.

Reishi Mushroom Powder, 100% Organic, 4 oz. Reishi is used as a tonic to help increase energy, improve digestion and sleep, strengthen resistance to disease, and regulate the immune system. It is widely used to improve the cardiovascular system, lower HDL (the 'bad' cholesterol), and reduce excess fatty acids.

Schizandra Berry Tincture, 2 fl. oz. In the early 1980s, Chinese doctors began researching Schizandra Berry as a treatment for hepatitis, and it is now recognized as an "adaptogen," capable of increasing the body's resistance to stress and disease.

Seabuckthorn Seed Oil, 100% Natural, 500 mg, 60 Softgels A rare source of vitamin E, Seabuckthorn Oil also provides other vitamins including Vitamins A, C, D, K, etc, carotenoids, flavonoids, phytosterols, amino acids, serotonin and 28 trace elements: iron, zinc, calcium, magnesium, selenium, iodine, etc.

Selenium, 100% Natural, 200 mcg, 100 Caps Selenium is an essential component of glutathione, the body's most potent natural antioxidant system. It is a popular choice in many antioxidant regimens.

Selenium Ionic Mineral Supplement, Fully Absorbable, 50 +/- ppm, 16 fl. oz. WaterOz Ionic Selenium is pure liquid Selenium supplement. Selenium promotes normal body growth, enhances fertility, encourages tissue elasticity and is a potent antioxidant that naturally reduces the retention of toxic metals in the body. Selenium is crucial for the proper functioning of the heart muscle and there is evidence that it can help the body fight cancer.

Stomach Fortifier, Balanceuticals, TCM Formula, 100% Natural, 60 Caps Chinese medicine uses it to strengthen the spleen and stomach, normalize peristalsis of the stomach and intestines, promote absorption of water and chlorine ion, improve metabolism, nurture the lung, balance bowel movement and increase energy.

Stomach Peace, Balanceuticals, TCM Formula, Ganweishu, 100% Natural, 400 mg, 60 Caps In China this product is extensively used for gastritis, peptic ulcer, abdominal pain, hepatitis, cholecystitis, costal neuralgia, kidney stone, cystitis, epilepsy, neurasthenia, anti-shock, anti-arrhythmia, mastitis, otitis media, costal chondritis, obstruction of Fallopian tube, chronic annexitis, hyperthyroidism and impotence.

Sutherlandia (Sutherlandia frutescens), 300 mg, 60 Tabs Sutherlandia powerfully assists the body to mobilize its own immunological physiological resources to cope with diverse physical, mental and chemical stressors.

The Hepatitis C Help Book, By Misha Ruth Cohen, Robert Gish & Kalia Doner The Hepatitis C Help Book contains programs for self-care, nutritional and fitness plans, and a comprehensive Western and Chinese medical treatment program. This indispensable guide also features new self-help information for the growing number of people who are considering or undergoing interferon treatment.

Thisilyn, Milk Thistle Extract, Vegetarian, Nature's Way, 175 mg, 100 VCaps Nature's Way Thisilyn, Milk Thistle Extract, is especially recommended for those who drink, smoke, or are exposed to environmental pollutants.

Turmeric Tincture, 100% Organic, 2 fl. oz. Turmeric is useful as an anti-inflammatory.

Vitamin C 1000 with Bioflavonoids, Nature's Way, 100% Natural, 1000 mg, 250 VCaps Nature's Way Vitamin C with Bioflavonoids provides antioxidant protection for many of the body's important enzyme systems.

Whole Reishi Mushroom, 4 oz. Reishi is used as a tonic to help increase energy, improve digestion and lower HDL (the 'bad' cholesterol), and reduce excess fatty acids. Also, Reishi has been shown to prevent and treat hardening of the arteries.

Herbal Remedies: Hepatitis Information

Herbal Remedies: Hepatitis Supplements & Products

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RECOMMENDED READING & HEPATITIS EDUCATION

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MAINTAINING A HEALTHY LIVER
HERBAL SUPPLEMENTS, RECOMMENDATIONS & NUTRIENTS

HERBS

Use Celandine and Silymarin ( Milk Thistle Extract) daily to help maintain liver function. Caution: Do not use Celandine during pregnancy.

Herbal Remedies: Liver Detoxifier & Regenerator, NOW Foods, 90 Caps

Herbal Remedies: Ultimate Liver Cleanse, Nature's Secret, 60 Tabs

Herbal Remedies: Ultimate Fasting Cleanse, Includes 2 Free CD's, Nature's Secret, 5 Part 5 Day Program

Herbal Remedies: Thisilyn, Milk Thistle Extract, Vegetarian, Nature's Way, 175 mg, 100 VCaps

Herbal Remedies: Milk Thistle Extract, Standardized, Nature's Way, 175 mg, 60 VCaps

Herbal Remedies: AlcohLiver Fix, Yangan, 60 Caps

Herbal Remedies: Colon & Liver Cleanser (CAC Liquid), 16 fl. Oz.

Herbal Remedies: Detox Support, NOW Foods, 90 Caps

Herbal Remedies: Celandine Supplements & Products

Herbal Remedies: Milk Thistle Supplements & Products

Liv-R-Actin from Nature's Plus is a good source of Milk Thistle. Take 2 capsules 3 times daily, before meals.

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RECOMMENDATIONS

Increase your consumption of foods high in potassium, such as almonds, bananas, blackstrap molasses, brewer's yeast, dulse, kelp, prunes, raisins, rice and wheat bran, and seeds.

Drink plenty of quality water. Steam-distilled water is recommended. When taking supplements, always take them with a full glass of water.

Avoid constipating foods. The liver has to work twice as hard if you are constipated. Be sure you diet contains sufficient amounts of choline, inositol, and lecithin, as well as bulk and fiber.

Do not smoke, and avoid alcohol, coffee, fish, fowl, meat, salt, soft drinks, sugar, tea, and spicy or fried foods.

Perform a 3 day fast once every 30 days. To help cleanse the liver while fasting, drink beet juice, carrot juice, black radish extract, and dandelion extract. Chlorophyll and distilled water with lemon are excellent blood purifiers and liver cleansers. Regular cleansing of the body, especially the liver, is vital to maintaining good health.

Do not take more than 10,000 IU of vitamin A daily on an ongoing basis, and avoid cod liver oil. Do not take more than 1,500 mg of niacin daily.

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CONSIDERATIONS

Animal studies indicate that the typical American diet is damaging to the liver. Improper diet results in allergies, digestive disorders, a low energy level, and an inability to detoxify harmful substances.

The four basic reasons for poor liver function are:

1. The presence of cumulative poisons. Insecticides, preservatives, and other toxins can build up in and impair the liver. Even though a particular toxin may not accumulate in the liver, liver function may suffer if the functioning of other organs, especially the pancreas and/or kidneys, is adversely affected by the toxin.

2. An improper diet. A diet that is low in protein and high in carbohydrates and fats, especially saturated fats, fried foods, and hydrogenated fats, is hard on the liver and may not provide sufficient protein building blocks necessary for repair. Poor food choices include processed foods, junk foods, refined white flour products, white sugar products, and imitation foods that are designed to appear and taste like an original product but that have been robbed of natural vitamins, minerals, and enzymes.

3. Overeating. Overeating is probably the most common cause of liver malfunction. Overeating creates excess work for the liver, resulting in liver fatigue. In addition, the liver must detoxify all of the various chemicals present in our food supply today. When the liver is overworked, it may not detoxify harmful substances properly.

4. Drugs. Drugs put a great strain on the liver. Drugs are substances that are foreign and unnatural to the body. These foreign substances cause the liver to work overtime in excreting these toxins. The liver neutralizes the effects of drugs on the body. Alcohol is particularly toxic to the liver. When excessive amounts of alcohol enter the liver, the liver begins to lose its functioning capacity. Other substances that can contribute to liver malfunction include oral contraceptives and caffeine.

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NUTRITIONAL SUPPLEMENTS

The following nutrients are important for healing once appropriate local treatment has been administered. Unless otherwise specified, the following recommended doses are for those over the age of 18. For a child between 12 and 17 years old, reduce the dose to 3/4 the recommended amount. For a child between 6 and 12 years old, use 1/2 the recommended dose, and for a child under 6, use 1/4 the recommended amount.

NUTRIENTS
Supplement	Suggested Dosage	Comments
Important
Coenzyme Q-10	60 mg daily.	Helps circulation and healing of tissue. Free radical scavenger that also increases the supply of oxygen to the cells and supplies oxygen to the liver. A potent liver protector. CoQ10, Vegetarian Coenzyme, NOW Foods, 30 mg, 60 VCaps, CoQ10, Now Foods, 400 mg, 60 Softgels
Free-Form Amino Acid Complex	As directed on label. Take on empty stomach.	A good source of protein that is easy on the liver because it has already been broken down. Amino 1000 Complete, NOW Foods, 120 Caps, Amino 1500, Chewable Blend of 20 Amino Acids, Predigested, NOW Foods, 150 Tabs
L-Cysteine And L-Methionine	As directed on label, on an empty stomach. Take with water or juice. Do not take with milk. Take with 50 mg vitamin B-6 and 100 mg of vitamin C for better absorption.	To aid in liver detoxification and protect the liver cells. See Amino Acids for more information. L-Cysteine Structural Support With Vitamin B-6 & C, Vegetarian, NOW Foods, 500 mg, 100 Tabs, NAC (N-Acetyl-Cysteine), NOW Foods, Selenium, Molybdenum, 600 mg, 100 Caps, L-Methionine Plus B-6, NOW Foods, 500 mg/10 mg, 100 Caps
Plus L-Glutathione	100 mg daily, before meals.	To aid in liver detoxification and protect the liver cells. L-Glutathione, NOW Foods, 250 mg, 60 Caps, ThioDox Glutathione Complex, Hypoallergenic, Allergy Research Group / Nutricology, 90 Tabs, Glutathione With Vitamin C, Hypoallergenic, Allergy Research Group / Nutricology, 60 Caps
Lecithin Granules Or Capsules	1 tablespoon 3 times daily, before meals. 1,200 mg 3 times daily, before meals.	Prevents fatty buildup in the liver. Lecithin Vegetarian Granules, 97% Phosphatides, Pure & Fresh, Now Foods, 1 lb., Lecithin Vegetarian Granules, 97% Phosphatides, Identity Preserved Non-GE, NOW Foods, 1 lb., Liquid Lecithin, Vegetarian, NOW Foods, 16 fl. oz., Lecithin, Fine Vegetarian Granules, 97% Phosphatides, Pure & Fresh, NOW Foods, 1 lb., Lecithin Concentrate, Nature's Way, 400 mg, 100 Softgels, Lecithin Supplement, Nature's Way, 1200 mg, 100 Softgels
Liver Extract Plus B-12 Injections Or Desiccated Liver	Injections: As prescribed by health care provider. As directed on label.	To supply needed B vitamins, iron, and other nutrients that help to rebuild the liver cells. Use liver from organically raised beef.
Vitamin B Complex	50 mg of each B vitamin daily, with meals 3 times daily (amounts of individual vitamins in a complex will vary).	Necessary for normal cell division and function and tissue repair. A sublingual form is best. Ultimate B (Vitamin B Complex), Nature's Secret, 60 Tabs, Liquid Yeast B Complex, Twinlab, 16 Fl oz., Vitamin B-100 Complex, W/ Coenzyme B-2, Nature's Way, 631 mg, 100 Caps, Vitamin B=50 Complex, W/ Coenzyme B-2, Nature's Way, 330 mg, 100 Caps,
And/Or Brewer's Yeast	As directed on label.	A good source of B vitamins. Brewer's Yeast, Debittered, NOW Foods, 1 lb., Brewer's Yeast, NOW Foods, 650 mg, 200 Tabs
Vitamin B-12	1,000 mcg twice daily.	Needed for protein synthesis and cell formation. Use a lozenge or sublingual form. Vitamin B-12 Complex Liquid, NOW Foods, 2 fl. oz., Vitamin B-12, Nature's Way, 2000 mcg, 100 Sublingual Lozenges, Vitamin B-12 Liquid Supplement, 50 mcg, With Vitamin B-9 (Folic Acid), 400 mcg, 1 oz., Vitamin B-12, California Natural, 1000 mcg, 60 Tabs, Vitamin B-12 LipoSpray, NOW Foods, 2 fl. oz.
Multi-Enzyme Complex	As directed on label.	Aids in digestion. Relieves the liver of some of its burden. MetabolicZyme (Hypoallergenic), Allergy Research Group / Nutricology, 900 Tabs, Plant Enzymes, NOW Foods, Vegetarian, 120 VCaps, Enzymes, All Complete, 250 mg, 90 Caps,
Multi-Enzyme Complex	As directed on label.	Aids in digestion. Relieves the liver of some of its burden. MetabolicZyme (Hypoallergenic), Allergy Research Group / Nutricology, 900 Tabs, Plant Enzymes, NOW Foods, Vegetarian, 120 VCaps, Enzymes, All Complete, 250 mg, 90 Caps,
Infla-Zyme Forte From American Biologics	As directed on label. Take between meals.	Reduces inflammation.
With Ox Bile	As directed on label.	Ox bile is a suitable supplement to the liver's production of bile. Ox Bile, Hypoallergenic, Allergy Research Group / Nutricology, 100 Caps
Multi-Vitamin & Mineral Complex	As directed on label.	To improve overall health and assure proper nutrition. All nutrients are needed in balance for healing and repair of tissues and for immune response. Multi-Vitamin With Minerals, Hi-Tech, 90 Caps, Liquid Multi-Vitamin & Mineral Complex With Trace Minerals, Orange Mango, 32 fl. oz., Liquid Multi-Vitamin & Mineral, Strawberry-Raspberry, Trace Minerals, 32 fl. oz., Multi-Vitamin Mineral Complete, Trace Minerals, 120 Tabs, Maxi Multi-Vitamin With Trace Minerals Liquid, 32 fl. oz., Alive! Whole Food Energizer, Liquid Multi-Vitamin, Trace Minerals, Citrus Flavor, Nature's Way, 30 oz., Super Multi-Vitamin & Multi-Mineral, Pure Vital Earth, 32 fl. oz. (98% Bio-Available for Absorption), Damage Control Master Formula, High Potency, Multi-Vitamin & Mineral, 60 Packets (30 Day Supply)
Phosphatidyl-Choline	As directed on labels.	For preventing fatty buildup and is important for energy production in the liver. Phosphatidyl-Choline, Derived From Soy, Allergy Research Group / Nutricology, 100 Softgels
Selenium	200 mcg daily. If you are pregnant, do not exceed 40 mcg daily.	A good detoxifier. Provides antioxidant protection at the cellular level. Powerful free radical scavenger and protector against cancer. Aids in protein digestion and protects against UV damage. Caution:Consult a health care provider before taking supplemental selenium if you are pregnant or have heart, kidney, or liver disease. Selenium Supplement, Yeast Free, NOW Foods, 200 mcg, 180 Caps, Selenium Ionic Mineral Supplement, Fully Absorbable, 50 +/- ppm, 16 fl. oz., Ionic Selenium, Trace Minerals, 300 mcg, 2 fl. oz., Selenium, 100% Natural, Nature's way, 200 mcg, 100 Caps
Vitamin C With Bioflavonoids	5,000 mg daily, in divided doses.	An important antioxidant. An immune enhancer. Neutralizes toxic substances. Vitamin C Liquid w/ Rose Hips & Bioflavonoids, Kosher, Natural Citrus Flavor, Dynamic Health, 1000 mg, 16 fl. oz., Ester C With Bioflavonoids, Nature's Way, 1000 mg, 90 Tabs, Vitamin C 1000 With Bioflavonoids, Nature's Way, 100% Natural, 1000 mg, 250 VCaps, The Right C, Nature's Way, 1000 mg, 120 Tabs
Vitamin E	200-600 IU daily.	A powerful antioxidant. Protects the liver from damage. Ester E Natural Vitamin E, California Natural, 400 IU, 60 Softgels, Vitamin E, 400 IU, 100% Natural, NOW Foods, 100 Gels, Vitamin E-1000, NOW Foods, 1000 IU, 100 Gels, Vitamin E, d-alpha-tocopherol, 400 IU, 100 Softgels, Vitamin E Skin Cream With Bee Pollen & Manuka Honey, 100 gm, Vitamin E Oil, 80% Mixed Tocopherols, Vegetarian, NOW Foods, 4 fl. oz., Vitamin E Oil, D-Alpha, Vegetarian, 32,000 IU, NOW Foods, 1 oz.
Zinc	30 mg daily. Do not exceed a total of 100 mg daily from all supplements.	Boosts the immune system, cell division, enzyme activity, and needed for growth and healing of tissues. Use zinc gluconate lozenges or zinc methionate (Optizinc) for best absorption. Zinc Ionic Mineral Supplement, Fully Absorbable, 100 +/- ppm, 16 fl. oz., Colloidal Silver & Zinc Lozenges, Silva Solution, 90 Lozenges, Zinc Lozenges W/ Echinacea & Vitamin C, Nature's Way, 23 mg, 60 Lozenges, Zinc (Chelated), 100% Natural, Nature's Way, 30 mg, 100 Caps

MoonDragon's Health & Wellness: The Liver

MoonDragon's Health & Wellness: Primary Biliary Cirrhosis



NOTIFY YOUR HEALTH CARE PROVIDER IF...

You or a family member has symptoms of hepatitis or has been exposed to someone who has it. Everybody should be periodically tested for hepatitis (as well as HIV). especially if you are in a high risk situation where it is possible you may be exposed to the virus, such as multiple sexual partners, intravenous drug use, blood transfusions, or working in a medical facility around patients that have the virus or in a lab that tests blood. Persons working as emergency medical technicians and police officers should be regularly tested for the virus.

The following occur during treatment:

• Increasing loss of appetite.



• Excessive drowsiness or mental confusion.



• Vomiting, diarrhea or abdominal pain.



• Deepening jaundice; skin rash or itching.

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MoonDragon's Health Information: Autoimmune Hepatitis

MoonDragon's Health Information: The Liver

MoonDragon's Health Information: Vaccinations

MoonDragon's ObGyn Information: HIV & AIDS

MoonDragon's Health Information: AIDS

MoonDragon's Health Information: AIDS & Nutritional Therapy

MoonDragon's Health Information: AIDS & Women

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