Hepatitis, or inflammation of the liver, is serious business. Short-term forms of hepatitis usually don't cause permanent liver damage. However, most people in the United States with hepatitis have a long-term, or chronic, form of the condition. Chronic hepatitis can lead to life-threatening liver damage. In fact, chronic liver disease and cirrhosis -- severe liver scarring that can progress to liver failure -- rank as the 12th leading cause of death in the United States, according to 2013 data from the Centers for Disease Control and Prevention. Medical therapies are the cornerstone of chronic hepatitis treatment, but many people look to supplements and herbs to support liver health. Silymarin and B complex vitamins are common choices. These substances are not curative for any form of hepatitis, but they might be beneficial in some circumstances.
B Vitamins, the Liver and Hepatitis
Vitamin B complex refers to the family of B vitamins, which includes thiamine, riboflavin, niacin, folate, biotin and vitamins B5, B6 and B12. These vitamins serve many important roles throughout the body but are particularly important in supporting some essential liver functions -- including detoxification of drugs and chemicals, and processing and metabolism of dietary proteins, fats and sugars.
B vitamin deficiencies occur in some people with advanced cirrhosis, which can result from various forms of hepatitis. People with alcoholic liver disease are particularly prone to B vitamin deficiencies. These deficiencies typically develop because of malnutrition, poor absorption of vitamins from the intestines and changes in blood circulation that result in increased loss of B vitamins through the kidneys. In people with chronic hepatitis that has not yet progressed to cirrhosis, vitamin B deficiencies can occur but are not common.
Silymarin, the Liver and Hepatitis
Inflammation is common to all forms of hepatitis. In the short term, inflammation helps fight infections and heal liver damage. Protracted inflammation, however, often triggers harmful changes that can lead to cirrhosis and liver cancer. Excess accumulation of chemicals called free radicals also occurs with many types of hepatitis and contributes to a type of liver cell harm known as oxidative damage.
Silymarin is a mixture of biologically active substances extracted from milk thistle seeds. A March 2013 "Hepatology" review of published studies on silymarin reports that this herb has consistently demonstrated antiinflammatory and antioxidant effects in a laboratory setting. Research conducted in people, however, remains inconclusive. Some studies have found evidence of these effects in people with various types of hepatitis, but others have not. An October 2007 study from the "Cochrane Database of Systematic Reviews" found no evidence to support or refute whether milk thistle benefits people with hepatitis caused by alcoholic liver disease, or infection with the hepatitis B or hepatitis C virus. The authors noted that human research to date is lacking in quality, and they recommend additional studies to determine whether silymarin might prove helpful to some people with hepatitis.
Indications and Expectations
B complex vitamins taken in recommended daily amounts are considered safe and are unlikely to cause side effects. However, vitamin B supplements are generally not recommended for people with hepatitis unless a deficiency is diagnosed. In people who do not have a vitamin B deficiency and have adequate dietary intake, extra amounts provided by supplements simply pass from the body in the urine.
Over-the-counter milk thistle supplements are also generally considered safe. But it’s important to understand that they may or may not be helpful for people with hepatitis. While laboratory experiments indicate that silymarin has effects that might be useful for hepatitis, there is no evidence to date that milk thistle supplements provide significant, lasting benefits in humans. Silymarin research is ongoing, however, as scientists hope to harness the beneficial effects seen in the laboratory and translate them into proven, useful therapies.
Warnings and Precautions
Hepatitis is a potentially life-threatening condition. No herbs or supplements -- including B complex vitamins and silymarin -- have been proved to alter the course of chronic hepatitis. While these substances might be helpful for some people, they cannot cure hepatitis and are not a replacement for medical therapy.
Talk with your doctor about whether vitamin B complex and silymarin might be helpful for you. This is particularly important if you have hepatitis C and are considering treatment with medicines known as direct-acting antivirals because milk thistle might reduce the effectiveness of your treatment.
Medical advisor: Tina St. John, M.D.
- Centers for Disease Control and Prevention: Deaths, Percent of Total Deaths, and Death Rates for the 15 Leading Causes of Death: United States and Each State, 2013
- Clinical Biochemistry and Metabolic Medicine, 8th Edition; Martin Andrew Crook
- Integrative Medicine, 3rd Edition; David Rakel, M.D.
- Journal of Gastroenterology and Hepatology: Malnutrition in End Stage Liver Disease: Recommendations and Nutritional Support
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- Clinical Hepatology: Principles and Practice of Hepatobiliary Diseases; Henryk Dancygier
- Hepatology: Hepatoprotective and Antiviral Functions of Silymarin Components in HCV Infection
- Cochrane Database of Systematic Reviews: Milk Thistle for Alcoholic and/or Hepatitis B or C Virus Liver Diseases
- AASLD/IDSA/IAS–USA: Recommendations for Testing, Managing, and Treating Hepatitis C: Initial Treatment of HCV Infection
- National Cancer Institute: Milk Thistle - For Health Professionals