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Q: Hepatitis C
I have Hepatitis C and was wondering if there would be two or three priorities in treating Hep C that you would recommend. I'm particularly interested in nutritional issues, supplements, and alternative therapies you may have heard of. Thank you.
A: Charlie Smigelski, RD responds:
Hepatitis C, (formerly known as NonA/NonB Hep), seems to be transmited through blood and other fluids. No cure yet, but medical treatment just got better. People are initially treated with Alpha Interferon, an obnoxious drug, with a low success rate. It is just an immune booster, and if the patient is also HIV+, there may not be much of an immune system to boost. The best new development is the approval of ribavirin for treatment. This is a nice antiviral drug. There are even studies where it zaps out the common flu virus in just a few days.
Hepatitis C obviously bothers the liver. Chronic liver inflammation and irritation leads to scarring (cirrhosis) and increases liver cancer risk.
In AIDS care, many people going on HAART (Highly Active Anti-Retroviral Therapy) find that their Hep C flares up. Some label this return of the immune system that could not otherwise mount some inflammation. Others think that HAART with a protease inhibitor, while anti-HIV, is also immune-suppressive for many other viruses and germs. (Note, CMV (cytomegalovirus) can also flare up during new treatment with HAART-PI)
The nutritional goal for those with both HIV and Hep C is to nourish the liver and protect it from the damage of stray electrons.
Important supplements are NAC 1.5 - 2.0 grams a day; L-glutamine at 5-10 grams a day, and maybe 0.5 grams of glutathione as well. The usual anti-oxidants, like 1-2 grams of vit C, 400-800 i.u. vit E, 25,000 i.u. beta carotene ( I urge food for this, not pills), plus SELENIUM. While I routinely suggest 200 mcg selenium a day for people who are HIV+, there is some evidence that 600 to 800 mcg of selenium actually reduced Hep C-induced liver inflammation. The Schiff vitamin home page has info on this I am told. Selenium at 400 mcg/day has reduced the risk of liver cancer for those with Hep B infection, it is likely useful for there here too.
(I see Chester has also included lipoic acid and carnitine in his suggestions. I agree.)
I have several patients on this regimen, including the lipoic and carnitine, their Crix tummy is lowering, and they have had no viral rebount in CMV or Hep C as their CD4 cells rose from 50 to 400, and their liver enzymes came down from the 200's to near normal.
Chester Myers, PhD, MS responds:
All the suggestions by Charlie for liver support, in reply to another question regarding lipodystrophy, would seem to apply here (so see Charlie's reply to that question).
I think the lipoic acid and carnitine are both of special importance. A diseased liver is impaired in its ability to synthesize carnitine, so some from a supplemental source seems in order. Of foods, only red meats supply significant quantities of carnitine, and lamb & mouton have the highest levels. Carnitor by prescription from your doctor (1-2 grams a day) is the best form. All the other compounds in the list are okay over-the-counter from a good health food or supplement store, or pharmacy.
Red meat is also a source of lipoic acid, and in this case leafy greens also provide some. But I have seen some dramatic improvements in liver enzymes (that were elevated from viral hepatitis) with 100 mg of supplemental lipoic acid twice a day.
I've been reviewing the literature on the Milk Thistle, and there appears to be no current evidence for concern regarding alteration of how the body deals with protease inhibitors. In fact, one study indicates that Milk Thistle may help prevent some of the problems associated with other compounds such as grapefruit juice.
The other herb that some find useful for helping liver repair itself is St. John's wort (used as per manufacturer's suggestions). BUT IF you are taking protease inhibitors, I'd be concerned for now that this might interfere. I'm not sure if the St. Johns wort might increase likelihood of PI toxicity, or if it might make it less effective, or simply have no effect. For now, we just don't have the information.
If you use the list given by Charlie (see the lipodystrophy question already referred to), but haven't been doing supplementation, I'd start with the lipoic acid and B-complex for 3-5 days, and then add in the others, a couple at a time every 2-3 days. A general multivitamin as baseline support would also be good to start.
The reason for not starting everything at once is that some formulations can cause allergic reactions for some people, in which case a brand change may help. If you get a reaction after starting everything at once, you won't know which was the problem. In general, changes are probably best made over a period of time - don't shock your body!
