DEAR DR. GOTT: I am a 60-year-old male with hepatitis C. I'm doing as much research as I can on this subject and would like your opinion on milk thistle and its benefits, if any.

DEAR READER: There are six hepatitis viruses, A, B, C, D, E and G, with C commonly considered to be the most serious. All forms attack the liver by causing inflammation that results in that organ's inability to function normally. With a long-standing diagnosis of hep C, cirrhosis, scarring and even cancer can result.

Symptoms may or may not be present in the early stages of the disease. When they do occur, they present with liver tenderness, fatigue, nausea, muscle and/or joint pain, and poor appetite. As the disease progresses, low-grade fever and jaundice, a yellowing of the skin, eyes and mucous membranes can result.

Common causes include exposure to contaminated blood, such as sharing needles from drug use; the use of contaminated needles for tattooing or body piercing; or receiving a blood transfusion before 1992. Before that date, blood-screening tests were not sophisticated enough to detect the disorder. A woman with the diagnosis can pass the virus on to a newborn. Contrary to some beliefs, hepatitis C isn't ordinarily transmitted through sexual contact, although in rare instances it can happen.

Testing is accomplished through a simple blood analysis. If the results come back positive, a physician might choose to measure the viral load in the blood so the best course of treatment can be decided. He or she may also choose to order a liver biopsy, a procedure in which a small sample of tissue is removed for analysis. While this procedure isn't vital, it will help determine the severity of the disease and will assist further with treatment options.

Most people infected with hep C develop a condition known as chronic hepatitis, and cirrhosis develops in about 20 percent of patients. A positive diagnosis does not mean treatment is necessary. Some people fight off the virus without treatment and without permanent damage. With minor abnormalities detected, a physician may choose to withhold treatment. That is a decision best left to the patient and his or her liver specialist.

Standard treatment is weekly injections of a drug called pegylated interferon alfa in combination with oral doses of ribavirin, a broad-spectrum antiviral taken twice a day for up to 48 weeks. This combination is up to 80 percent effective in clearing the virus from the bloodstream. Minor side effects of the duo that may improve over time include skin irritation, insomnia, flu-like symptoms and more. End-stage disease treatment is done through liver transplant. Unfortunately, the number of people on transplant lists far outweighs the number of available livers.

On the home front, maintaining a healthy lifestyle, avoiding medications such as acetaminophen and some prescription drugs that may cause liver damage, and reducing alcohol consumption are appropriate first steps. Milk thistle has been used for hundreds of years in Europe as a treatment for jaundice and some liver disorders. It will not cure hepatitis C, nor will it prevent healthy people from contracting the virus. What is known about this over-the-counter product is that silymarin, the primary ingredient, may help heal the liver because it appears to stimulate the production of antioxidant enzymes that neutralize liver toxins and reduce inflammation.