Provided by Clinical Care options
Mixed Realities of Alternative Therapies for Hepatitis
Approximately 50% of patients who have failed initial therapy for hepatitis C take some form of alternative or complementary therapy. In my practice, I’m frequently asked by these and other patients: “What can I do to help my liver?” Most have heard of, have taken, or are taking milk thistle, licorice root, ginseng, schisandra, and/or thymus extract—with milk thistle being the most common. Not all alternative therapies are created equal and there are few randomized controlled trials to guide clinicians seeking answers. For instance, the active ingredient in milk thistle, silymarin, has been evaluated and generally found to provide little or no clinical benefit to the liver. In fact, a recent study found that even at higher-than-usual doses, silymarin failed to reduce HCV RNA or ALT levels more than placebo.
There is, however, a growing body of research supporting a beverage I’d wager a majority of you have enjoyed today: coffee.
The Coffee Alternative
Curiously, patients who will spend up to $30 a day or more for milk thistle and its extracts or ingest unproven therapies of varying quality are skeptical about the idea that drinking coffee can actually be good for you. Real and perceived cardiovascular and other effects of coffee have led many patients to view coffee as “unhealthy.” But the reality is that coffee consumption has been linked to a number of potential benefits – lower risk of diabetes, dementia and, yes, liver disease. Coffee contains more than 1000 compounds; one or more of which is responsible for the benefit that has been linked to coffee intake on liver disease in patients with alcoholic and viral hepatitis. Benefits include decreases in markers of liver disease progression and reductions in the risk for fibrosis and hepatocellular carcinoma.
Epidemiologic studies have suggested that there is a cause and effect associated with coffee intake and its benefits on the liver. These findings are supported by the few randomized controlled trials available. In one study comparing patients infected with hepatitis C, those who drank 3 cups of coffee per day or more received the greatest benefit. In order to maximize the effects of the coffee some (but not all) studies suggest that caffeinated coffee may be better for the liver than decaffeinated coffee. However, it seems that caffeine itself does not appear to have a beneficial effect.
There is also an interesting conundrum. Not just any caffeinated beverage will do. For instance, studies evaluating the effect of green tea – popularly considered a “healthier” source of caffeine – have not shown the benefits associated with filtered, caffeinated coffee. This lack of benefit appears to be true for sources of caffeine other than green tea as well.
Lastly, coffee should ideally be prepared by filtration because filtering removes cafestol and kahweol, two substances found in coffee that may increase serum cholesterol.