a.melon

Milk thistle (scientific name Silybum marianum) is a plant from the aster
family. The active extract of milk thistle believed to be responsible for the
herb's medicinal qualities is silymarin, found in the fruit.6 Milk thistle has
been used in Europe as a treatment for liver disease and jaundice since the
16th century.7

Summary of the research findings

* The results of scientific studies to date do not definitively find that
milk thistle is beneficial in treating hepatitis C in humans.

* Studies in laboratory animals suggest that silymarin may have various
benefits to the liver, such as promoting the growth of certain types of liver
cells, having a protective effect upon liver cells, fighting a chemical process
called oxidation that can damage cells, and inhibiting inflammation.7-14
However, in some cases, a consistent pattern of benefit was not seen, and these
studies did not specifically examine the effects of silymarin on
hepatitis C.

* There have been some studies on silymarin or milk thistle in humans.
These studies have generally been small and on liver diseases rather than on
hepatitis C infection specifically, and the results have been contradictory
(with some positive and some negative).15-17 A review and a meta-****ysis
published in 2001 on silymarin in the treatment of liver diseases found it to
be generally safe, but contained no firm conclusions with regard to its use to
treat viral hepatitis.18,19 A 2002 systematic review on milk thistle for liver
disease found "no reduction in mortality (frequency of death as an outcome), in
improvements in histology (tissue studies) observed through liver biopsy, or in
biochemical markers of liver function" and that the data was too limited to
support recommending milk thistle for treatment of liver disease.20

To obtain more extensive and reliable data, NCCAM is sponsoring a clinical
trial on the use of milk thistle for hepatitis C.

Side effects and other risks
Milk thistle is generally well-tolerated and has shown few side effects in
clinical trials. It can cause a laxative effect; less common effects include
nausea, diarrhea, abdominal bloating, fullness, and pain. Milk thistle can
produce allergic reactions, which tend to be more common among people who are
allergic to plants in the same family (e.g., ragweed, chrysanthemum, marigold,
and daisy).

Licorice Root
Licorice root is the peeled or unpeeled dried root of the licorice plant
(Glycyrrhiza glabra). The primary active component of licorice root is a
substance called glycyrrhizin. Licorice root has been in use in China since the
second and third century B.C. and in the West since Egyptian, Greek, and Roman
times.21

Summary of the research findings

* Laboratory studies of glycyrrhizin in cell cultures suggest that it may
have antiviral properties.21

* In a review of several randomized controlled trials, researchers reported
that glycyrrhizin has potential for reducing long-term complications in chronic
hepatitis C in those patients who may not respond to interferon.22 Several of
the trials reviewed indicated improvements in liver tissue damaged by
hepatitis. Some also showed improvements in how well the liver did its job
after treatment.

* A 1997 study and a 2002 review suggest that long-term administration of
glycyrrhizin might prevent liver cancer in patients with chronic hepatitis
C.23,24

* The use of glycyrrhizin as a complementary therapy (i.e., used in
addition to conventional interferon therapy) has been studied, but no
significant benefit has been found.25,26

* Recent clinical trials have shown that taking glycyrrhizin lowers the
levels of liver enzymes (increased levels of certain liver enzymes indicate
liver damage or inflammation). However, taking the herb did not reduce the
amount of HCV in patients' blood, a critical indicator of the long-term
progress of the infection.27-29

Side effects and possible risks
Taking licorice over a prolonged period of time can lead to potentially serious
side effects, including high blood pressure, salt and water retention,
swelling, depletion of potassium, headache, and/or sluggishness.30 Glycyrrhizin
can worsen ascites, the ac***ulation of fluid in the abdominal cavity, a
condition that can be caused by cirrhosis.31 The herb also can interact with
certain drugs, such as diuretics, digitalis, antiarrhythmic agents, and
corticosteroids.

Ginseng
The herb ginseng comes in two types: American ginseng (Panax quinquefolius) and
Asian ginseng (Panax ginseng). Among the Asian forms of ginseng are Chinese,
Japanese, and Korean ginseng. (So-called "Siberian ginseng" is not a true
ginseng.) Ginseng has been used for thousands of years in Asia. It is usually
used with the belief that it will boost the immune system and increase stamina;
such properties are thought to be more useful for the elderly and those
recovering from illness.32

Summary of the research findings

* The research on ginseng that has been done to date has been primarily in
animal models and human tissue in the laboratory. Some beneficial effects of
ginseng on the liver were seen in these studies. Researchers concluded that
ginseng may also help strengthen glandular systems and the ability to resist
disease.33-36

* One study found that ginseng may be helpful for elderly people with liver
conditions similar to hepatitis.37

* No conclusions can be drawn about the possible usefulness and safety of
ginseng as a treatment in people who have hepatitis C, because it has not been
studied formally yet in people.

Side effects and possible risks
General adverse (negative) effects of ginseng can include insomnia, headache,
nosebleed, nervousness, and vomiting. Prolonged use of caffeine and a high dose
of ginseng may be associated with hypertension, which is of particular concern
for people with cardiovascular disease or diabetes. In addition, people with
diabetes who use insulin should be aware that ginseng has demonstrated
hypoglycemic effects (lowering of the blood sugar). Ginseng has been shown in
laboratory studies to inhibit grouping of platelets in the blood, increasing
bleeding risk. Because of this, using ginseng along with NSAIDs (non-steroidal
anti-inflammatory drugs), such as aspirin or ibuprofen, should be discussed
with your health care provider.32

Thymus Extract
The thymus is a gland that is involved in the regulation of the body's immune
response. Thymus extract products consist of peptides taken from the thymus
glands of cows or calves and are sold as dietary supplements. Often, these
products carry claims of boosting immune system functioning to combat diseases,
such as hepatitis C. These over-the-counter supplements should not be confused
with the prescription drug thymosin alpha-1.

Summary of the research findings
There has been little testing of bovine thymus extract for treatment of
hepatitis C. A small clinical trial of a product called Complete Thymic
Formula, which contains bovine thymus extracts along with vitamins, herbs,
minerals, and enzymes, did not find the product beneficial for hepatitis C
patients who had not responded previously to interferon therapy.38 However,
this small study does not provide sufficient evidence to draw firm conclusions
about either Complete Thymic Formula or thymus extracts in general.

Side effects and possible risks
In the study of Complete Thymic Formula, one adverse event was reported: a
patient developed thrombocytopenia, a drop in the number of platelet cells in
the blood; the patient recovered after treatment was stopped.38 In general, no
adverse effects from thymus extracts have been reported. However, since thymus
extracts are derived from animals, there can be concern related to possible
contamination from diseased animal parts.k Accordingly, people on
immunosuppressive drugs or who have suppressed immune systems, such as
transplant recipients or persons with HIV/AIDS, should use caution about thymus
extracts and consult with their health care provider.

kWith regard to side effects, see "Sources: General," item F, entry on thymus
extract.

Schisandra
Schisandra is a plant that has been used (through extracts from its fruit) in
traditional Chinese medicine and in Kampo, traditional Japanese medicine. There
are several species, including Schisandra chinensis, native to northeastern
China and Korea, and Schisandra sphenanthera, native to China.

Summary of the research findings

* Research has primarily focused on the various lignans (a class of plant
nutrients) and essential oils in the dried fruit of schisandra.39 Major
constituents include the lignans gomisin A, schizandrins and schizandrol,
vitamins C and E, and others.

* Studies of the effects of schisandra in the liver have mostly been in
animal models. These studies have suggested that extracts of the fruit have a
liver-protective effect, a helpful effect on some liver enzymes, and an
antioxidant effect.l,39,40

* Schisandra is also used in herbal formulas. For example, an herbal
medicine called TJ-108 (Ninjin-yomei-to is one of its Japanese names) used in
Kampo has schisandra fruit among its herbal components. In one very small
study, TJ-108 was compared with two other Kampo herbal formulas for effects in
37 patients who had chronic hepatitis C and had been treated before with
interferon.41 The findings were that TJ-108 may have antiviral properties,
which the authors attributed to schisandra fruit and its lignan gomisin A.7,41
These findings need to be interpreted with caution because of the study's small
size and because use of an herbal formula, not schisandra alone, was evaluated;
herbal formulas contain many ingredients that could cause a variety of effects.

* There are no reports on the safety and effectiveness of using schisandra
alone for treatment of hepatitis C in humans in the sources reviewed for this
report.

Side effects and other risks
Schisandra is considered generally safe. In some people, however, it may cause
heartburn, acid indigestion, decreased appetite, stomach pain, or allergic skin
rashes.

Antioxidants are substances (such as vitamin E) that help prevent oxygen from
reacting with other chemicals in cells (oxidation), a process that can have
negative effects.

Colloidal Silver
Silver is a metallic element that is found both in nature and in living
organisms. Colloidal silver consists of tiny silver particles suspended in a
solution. As a dietary supplement, colloidal silver is marketed with a variety
of health claims, including for immunity, diabetes, cancer, and AIDS.

Summary of the research findings
Silver has had past uses in medicine, dating back to the Middle Ages. However,
the advent of drugs has eliminated the vast majority of these uses. Reviews in
the scientific literature on colloidal silver, including by staff of the U.S.
Food and Drug Administration (FDA), have concluded that42,43:

* The use of colloidal silver can cause serious side effects.
* Silver has no known role in the body.
* Silver is not an essential nutrient and should not be promoted as one.
* It has not been proven that silver has any role in immunity or any
effectiveness against any diseases.
* The amounts of silver in silver supplements have been ****yzed and found
to vary greatly.

Side effects and other risks
Animal studies have shown that silver ac***ulates substantially in the body. In
humans, this ac***ulation can have a serious side effect called argyria, a
bluish-gray discoloration of the body, especially of the skin, nails, and gums.
How this happens is not fully known, but silver-protein complexes are thought
to deposit in the skin and then be catalyzed by sunlight, in a process similar
to traditional photography.44,45 Argyria is not treatable or reversible. Other
possible problems include gastrointestinal distress, headaches, and seizures.