More than one-third of Americans use herbs for health purposes, yet patients and physicians usually lack accurate information about safety and efficacy of herbal remedies. In recent years, there has been a substantial increase in the use of so-called complementary and alternative therapies by patients with liver disease. Medical professionals and laboratorians need to be informed about popular alternative therapies and be open-minded to the possibility that some benefit may come from some therapies currently regarded as alternative. Silymarin extracted from the milk thistle is most widely subscribed to as a remedy for liver diseases. The beneficial effects of silymarin are most often seen in the patients who had cirrhosis as a result of alcohol abuse. An ongoing clinical trial will provide some insight as to whether milk thistle directly affects HCV. Silymarin has a good safety record and only rare case reports of gastrointestinal disturbances and allergic skin rashes have been published. The active component of licorice root, glycyrrhizin, has been shown to reduce alanine transaminase and aspartate transaminase values in the serum. This protective function has recently been explained as the inhibitory effects of glycyrrhizin on immune-mediated cytotoxicity against hepatocytes and on nuclear factor (NF)-kappa B, which activates genes encoding inflammatory cytokines in the liver. Finally, some patients with hepatitis C take St. John's Wort and ginger to treat the side effects caused by interferon therapy. An excellent review of this subject was recently published by the NCCAM.
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