When people talk about hepatitis, they usually mean viral hepatitis.  However, there are other causes.  Alcohol is the most obvious causing an inflammation and fatty infiltration of the liver leading to cirrhosis in some heavy drinkers.  Alcoholic cirrhosis kills tens of thousands of Americans per years.  In addition to alcohol, medications can cause hepatitis as a side-effect, as with valproic acid (Depakote and others) or from an overdose, as from acetaminophen (Tylenol and others).

Viral hepatitis, especially hepatitis B and C are serious and growing problems in the U.S.  Hepatitis B vaccination is now routine in children and will probably dramatically reduce this health hazard a couple decades from now.  However, no vaccination exists for hepatitis C, which is the leading killer through cirrhosis and liver cancer.  These are both spread primarily through IV drug abuse and having multiple sexual partners.

Hepatitis A continues to be a problem, but usually of a more short-term nature.  It is usually spread by fecal-oral contamination.  A vaccination is also available for it.  

Hepatitis D sometimes accompanies hepatitis B and hepatitis G sometimes accompanies hepatitis C.  These apparently do not require special treatment or at least I haven't seen much on them.  There is also a hepatitis E virus which is prevalent in India.  

Hepatitis C is becoming the big viral hepatitis menace.  It gets its own webpage.

I strongly recommend high dose Vitamin K to anyone infected with hepatitis B virus (HBV) or hepatitis C virus (HCV).  It is very inexpensive, only $7 per month.  While I haven't found the same potent dosage used in the below study, a less potent dosage, but still 100 times the government recommended intake (10 mg vs. 0.1 mg) and 600 times the amount found in standard multivitamins (0.017 mg).  It is available from www.iherb.com and other sources.  The research was actually done with a still stronger dose of vitamin K(2) 45 mg. not available in the U.S.  Taking four or five of my recommended 9 mg. K(1) with 1 mg K(2) capsules would probably replicate the Japanese dose, but such an extremely high dose might not be necessary.  Milk Thistle may also help.

Cancer of the Liver: Vitamin K Prevented Liver Cancer is Viral Hepatitis: In a DB PC study of 40 women with an average age of 60 and with viral liver cirrhosis (mostly Hepatitis C), only 2 of 19 women on 45 mg/d of vitamin K2 vs. 9 of the 19 women on placebos. On multivariate analysis with adjustment for age, alanine aminotransferase activity, serum albumin, total bilirubin, platelet count, alpha-fetoprotein, and history of treatment with interferon alfa, the risk ratio for the development of hepatocellular carcinoma in patients given vitamin K2 was 0.13 (P =.05). Role of vitamin K2 in the development of hepatocellular carcinoma in women with viral cirrhosis of the liver. Habu D, Shiomi S, Tamori A, Takeda T, Tanaka T, Kubo S, Nishiguchi S. Osaka City University. JAMA. 2004 Jul 21;292(3):358-61.  Ed: This study was undertaken to determine the value of vitamin K in preventing osteoporosis in older women with liver problems.  The 87% decrease in liver cancer risk was an unexpected finding, according to Shiomi.  Oddly, the evidence that vitamin K is active against liver cancer dates from lab studies from the University of Pittsburgh published in May, 1998 in The Journal of Biological Chemistry. Brian Carr, MD, director of the Liver Cancer Center at the University of Pittsburgh Cancer Institute said then, "We now know that the vitamin K compounds not only can kill liver cancers, but also can destroy other types of cancer in tissue cultures, including breast cancer and melanoma. It appears to stop cancer cell growth without producing toxicity. We now are testing this compound against cancers in rats, and given positive results, we hope to begin clinical trials of this agent within two years." Liver cancer is thought to be one of the three most common cancers worldwide. The disease caused about 15,000 U.S. deaths in 1997. Major causes of this cancer include infection with either hepatitis B or C or chronic alcohol consumption. 

Cancer: Vitamin K Appeared to Help Liver Cancer: In a study of 40 hepatocellular carcinoma patients receiving oral K1 (40 mg/day), all patients evaluated had a 20% tumor response rate, with five patients living greater than one year on treatment. Hepatology 1996;348A. The same research team reported a phase I/II trial of K1 with hepatoma patients which resulted in decreased cancer growth. Cart BI. A phase I/phase II study of high dose vitamin K(VK) to patients with advanced inoperable hepatocellular carcinoma (HCC): interim analysis. Hepatology 1994;20:278A.

Cancer: Liver Cancer Vitamin K Treatment Studied: In a study of 14 hepatocellular carcinoma patients given vitamin K1 20 mg twice daily until disease progressed, four of the nine able to be evaluated were reported to have stable disease, while five progressed. No toxicity was found in any of the participants. Zaniboni A, Biasi L, Graffeo M, et al. Phase II study of high-dose vitamin K1 in hepatocellular carcinoma: a GISCAD study. ASCO 1998:17:1182.

Cancer: Liver Cancer Slowed by Vitamin K: In a Japanese trial of 121 patients with hepatocellular cancer undergoing conventional therapy (percutaneous tumor ablation and/or transcatheter arterial embolization), patients were given 45 mg/day oral vitamin K2. Portal vein invasion after 12 months was 2% with K2 vs. 23% for controls. At two years, 23% of K2 patients vs. 47% of controls were found to have invasion into the portal vein. Jancin B. Vitamin K cuts hepatocellular CA mortality. Fam Pract News 2002;32:16. 

Cancer: Coffee Linked to Lower Liver Cancer Rates: In a study of 90,452 middle aged and elderly Japanese, there were 334 cases of liver cancer. Those who drank coffee almost every day had a 51% lower liver cancer risk than those who almost never drank coffee. The higher the intake of coffee, the lower the risk of liver cancer. Coffee drinking lowered the risk of liver cancer in individuals with hepatitis C, with a trend toward lowering the risk in individuals with hepatitis B, even after adjustment for alcohol and tobacco intake. Inoue M, Yoshimi I, et al. Influence of coffee drinking on subsequent risk of hepatocellular carcinoma: A prospective study in Japan. Journal of the National Cancer Institute. 2005;97:293-300.

Cancer: Hepatocellular Cancer: Most hepatocellular cancer (HCC) is caused by hepatitis B and C. There are 350,000 cases world-wide annually, especially China and Asia with 7,000 in US. 80% have cirrhosis due to chronic viral hepatitis. Hemochromatosis increases death although iron depletion before cirrhosis was helpful. Chronic infection with hepatitis B virus (HBV) is strong risk factor with risk ratio for HCC greater than 100 for those HBsAg positive at start of study. Newly infected adults less likely to become chronic carriers than young children. Adults who experience acute HBV infection and recovery have little if any increase risk of HCC. Up to half the HCC in US may be due to HCV. Chronic hepatitis C treated with interferon decreases the risk of HCC if the patient responds to treatment. Lancet ’99;353:1253-7

Cancer: Hepatocellular Cancer Up in US: Due to higher rates of Hepatitis B and C from 1960-85, and a 10-30 year latency period, hepatocellular cancer rates have increased from 1.4/100,000 to 2.4/100,000 (NEJM ’99;340:745-50). Rates are higher in males and African-Americans each by a factor of 3. Nearly 4 million are infected with HCV and hepatocellular cancer will develop in 6-7%. 

Carnitine: Cirrhotic Encephalopathy Helped by Carnitine: Hepatic encephalopathy (HE) is one of the major complications of cirrhosis. In a 60-day DB PC study of 120 patients, L-carnitine (2 g twice a day) significantly reduced ammonia levels and had a protective effect against ammonia-precipitated encephalopathy in cirrhotic patients. Improvement occurred with first month and was marked by the end. L-Carnitine in the treatment of mild or moderate hepatic encephalopathy. Malaguarnera M, Pistone G, et al. Catania, Italia. Dig Dis. 2003;21(3):271-5.

Carnitine: Hepatic Encephalopathy Helped: In a 90 Day DB PC study of 150 patients with hepatic encephalopathy (10 patients with alcoholism, 41 patients with hepatitis virus B infection, 78 patients with hepatitis C virus infection, 21 patients with cryptogenetic cirrhosis), L-carnitine (2 g twice a day) caused a great decrease in NH4 fasting serum levels (P<0.05). Differences were also found between symbol digit modalities test and block design (P<0.05). There is an important protective effect of L-carnitine against ammonia-precipitated encephalopathy in cirrhotic patients. Effects of L-carnitine in patients with hepatic encephalopathy. Malaguarnera M, et al. Catania, Italy. . World J Gastroenterol 2005 Dec 7;11(45):7197-202. 

Carnitine Liver Damage of Depakote May Have Been Helped: Valproate hepatotoxicity is rare but often fatal, and long-term valproate therapy may induce a carnitine deficiency and cause non-specific symptoms of hepatotoxicity and hyperammonemia. A case of valproate-induced acute liver injury doing well after L-carnitine therapy is reported. A case of valproate-associated hepatotoxicity treated with L-carnitine. Romero-Falcon A, de la Santa-Belda E, et al. Sevilla, Spain. 2004

Carnitine Used for Valproic Acid Overdoses: Three years of poison center charts from more than 300,000 patients were reviewed; 674 patients ingested valproic acid. l -Carnitine was routinely recommended if the ammonia level was elevated. Fifty-five doses of carnitine were administered to 19 patients who had isolated VPA ingestions and 196 doses of carnitine were administered to patients with mixed overdoses that included VPA, all with an elevated ammonia level. No patient had a documented allergic reaction or side effects. l-carnitine was safely administered in the setting of valproate toxicity. Lovecchio F, Shriki J, Samaddar R. Am J Emerg Med. 2005 May;23(3):321-2.

Liver Transplant: Resveratrol has an immunosuppressive effect on lymphocytes under allograft rejection in rat. Inducing apoptosis of lymphocytes and upregulating the ratio of Bax/bcl-2 proteins in lymphocytes in allograft liver may be part of the mechanisms. Pharmacol Res 2006 Mar 2.

Nonalcoholic Fatty Liver Disease: Metformin Effective: In an open label, randomized trial, nondiabetic patients with Nonalcoholic Fatty Liver Disease were given metformin (2 g/day) for 12 months or vitamin E (800 IU/day) or were treated by a prescriptive, weight-reducing diet (n = 27). Aminotransferase liver enzyme levels improved in all groups in association with weight loss. The effects of metformin were larger (p < 0.0001), and alanine aminotransferase normalized in 56% of cases (OR vs. controls, 3.11; p= 0.0013). In multivariate analysis, metformin treatment was 500% more likely to have aminotransferase normalization, after correction for age, gender, basal aminotransferases, and change in body mass index. The criteria for metabolic syndrome were reduced only in the metformin arm (p= 0.001). A biopsy in 17 metformin-treated cases (14 nonresponders) showed a significant decrease in liver fat (p= 0.0004), necroinflammation, and fibrosis (p= 0.012 for both). No side effects were observed during metformin treatment. A Randomized Controlled Trial of Metformin versus Vitamin E or Prescriptive Diet in Nonalcoholic Fatty Liver Disease. Bugianesi E, Gentilcore E, et al. University of Turin, Italy. Am J Gastroenterol 2005;100:1082-1090.

Osteopororsis High in Viral Hepatitis Infected: In 43 patients with HCV or HBV infection without liver cirrhosis (mean age 49), BMD was lowered in 58% of the patients, 19% with osteoporosis. Bone-specific alkaline phosphatase (P = 0.005) and intact parathyroid hormone (iPTH) (P = 0.001) were significantly elevated in the more advanced stages of fibrosis. Mean T-score value was lower in patients with chronic hepatitis C as compared to patients suffering from chronic hepatitis B (P = 0.09). Reduced bone mineral density and altered bone turnover markers in patients with non-cirrhotic chronic hepatitis B or C infection. Schiefke I, Fach A, et al. University of Leipzig, Germany. World J Gastroenterol. 2005 Mar 28;11(12):1843-7.

Vation Against Hepatitis B Causes Increase in MS, Lupus, Rheumatoid Arthritis, and Other Autoimmune Diseases: In a case-control epidemiological study, adults receiving HBV vaccine had significantly increased odds ratios (OR) for multiple sclerosis (OR = 5.2, p < 0.0003), optic neuritis (OR = 14, p < 0.0002), vasculitis (OR = 2.6, p < 0.04), arthritis (OR = 2.01, p < 0.0003), alopecia (OR = 7.2, p < 0.0001), lupus erythematosus (OR = 9.1, p < 0.0001), rheumatoid arthritis (OR = 18, p < 0.0001), and thrombocytopenia (OR = 2.3, p < 0.04) in comparison to the tetanus vaccine group. The chances of exposure to hepatitis B virus in adults is largely life-style dependent.  A case-control study of serious autoimmune adverse events following hepatitis B immunization. Geier DA, Geier MR. Silver Spring, MD. Autoimmunity. 2005 Jun;38(4):295-301.