By Darlene Morrow, BSc
A
special thanks to my friend, Smilin’ Sandi for her feedback and help with this
paper. You can visit Sandi at http://www.creativeintensity.com/smking/
This
entire document was typed using voice recognition software that was donated to
me by Lernout and Hauspie. So a big
thanks goes to them. If I missed any of the contextual errors, please
excuse me. J
You
might ask how I come to write a nutrition article? I have my bachelor's degree from
Throughout
this article I will mention that there are things that you should watch. By that I mean that these items can cause an elevation
in liver enzymes in sensitive individuals.
The best thing for you to do is to consult your physician, tell him/her
that you are interested in adding a particular item or product, and that you
would like to monitor your liver enzymes before and after to make sure that
everything is all right.
Don't
add more than a one new thing at a time.
You won’t know what worked or caused a problem. If something happens, it is usually in the
initial phase or after prolonged use.
Rules
of thumb:
1.
You need to take something for 3 months before you know if it works.
2.
Take a week off every 3 months.
How long I stay on something depends on the product
but it is usually never longer than 3 months and can be as little as a
month. In the case of Echinacea I never
take it for more than 2 weeks.
You
need to remember that you are an expert on your own body. You just have to learn to listen to the
signs. That means that anytime you feel
nauseated or uncomfortable or pain when you have added something new to your
regime, you should stop.
If you're doctor prescribes a new medication for you, and you feel sick because of it, contact your doctor immediately and stop taking the medication until you see him. But never abruptly stop taking a medication that you have been on for a period of time. If you think the medication is a problem, go see your doctor immediately.
Alcohol
should be avoided. Studies have shown
that alcohol can accelerate the damage caused by the hepatitis c virus. The
studies have been inconclusive as to the amount of the alcohol that causes this
to happen. However all studies agree
that regular alcohol consumption is a large problem. Personally I would avoid
all alcohol.
Alcohol
also reduces the rate of metabolism and the secretion of fat. This can contribute to fatty liver and
cirrhosis.
You
might also want to watch the alcohol in cough syrup, in herbal tinctures like
Echinacea and in chocolates that contain liquor like cherries. Most of these
products are now available without alcohol but you might have to ask that the
pharmacy counter to get them.
Alcohol is often used in cooking in restaurants. This is fine it if it's cooked because the alcohol boils off but if it's not been heated, the alcohol is still there.
Fat
soluble vitamins (vitamins A, D and E) are stored in the liver. Vitamin A, one of the fat soluble vitamins
should not be taken by people with hepatitis c.
That includes its precursor beta carotene. Studies have shown that there is an increase
in the damage of the liver particularly when these compounds are taken with
alcohol.
Vitamin
D is necessary for bone metabolism however there have been some reports of
caution with higher doses in people with hepc.
This would include the dosage of 1,000 IU that is recommended for people
that suffer from osteopenia (pre osteoporosis). As women enter into menopause
the complications due to hepatitis c compound treatment.
People
with hepatitis c often have a complication called hematochrosis. This is iron deposits in the liver tissue
itself. This is a very dangerous
condition and patients are often treated with phlebotomies (the removal of a
portion of blood). Furthermore there is
speculation that the virus uses iron in its life cycle. For these reasons iron should be
avoided. If you suffer from this
condition, I would also avoid cooking in iron pots as the iron is leached out
into the food.
Also
watch for iron enriched cereals and other bread products.
Reduction
of saturated fats in the diet is a good recommendation regardless of disease
state. Because of the alteration in bile
production and its necessity for the metabolization of fats many people find
they feel better when they monitor their fat intake.
Steatosis
(fatty deposits in the liver) is seen in hepatitis c and although the
relationship between dietary fat and fatty liver has not been conclusively
proven the average Canadian diet could safely be reduced in fat (particularly
saturated fat). In addition high cholesterol values are sometimes seen as a
result of interferon therapy.
It
should be noted here that there are concerns about high cholesterol associated
with other diseases seen with hepatitis c.
Problems with low thyroid, diabetes and a decrease in estrogen (also
compounded by aging) can all contribute to high cholesterol.
Hypoglycemia? The liver breaks down
hormones. If insulin is not broken down
quickly enough hypoglycemia can occur.
A little nasty? Failure of the liver to break down adrenaline can lead to chronic irritability and temper explosions.
Protein
metabolism- Brain Fog?
Physicians believe that cognitive difficulties,
poor short-term memory, and confusion only occur in patients with cirrhosis. I think that this information is
incorrect. I believe that these problems
(which are commonly referred to as brain fog by hepc’ers) can occur at much
earlier stages. I know too many people that have a lesser stage of disease and
a big problem with this. It seems to be
transient in nature.
If you notice this problem, you might consider
restricting the amount of protein that you eat.
Protein contains an ammonia molecule.
In cirrhosis protein metabolism is affected and the body is not able to
clear this molecule. It is usually
removed by conversion to urea which is synthesized in the liver. If it is not taken out of the blood it can
accumulate and lead to hepatic coma. As
it builds it causes many cognitive problems and it is common for people with
cirrhosis to be restricted in their protein intake in addition to being
prescribed lactulose, which reduces the circulating ammonia.
It is important to note that you must have a
minimum of 20-30 grams of protein in your diet to prevent protein loss from
muscle tissue. And in a newly released
study this week it was noted that between 45-55% of Canadian women do not meet
the daily minimum requirements for protein.
Another thing to keep in mind is that we want
the liver tissue to regenerate. To make new tissue you must have protein. So
too much or too little protein is a problem.
If you become aware of an increase in cognitive
difficulties, try reducing your protein.
Many people feel better when they do not eat red meat. Chicken and fish
does not seem to be as big a problem.
Special note: A lack of insulin production (diabetes)
also leads to a reduction in protein synthesis.
The
usual salt restriction is 2 grams per day. People with hepatitis c often have a
problem with fluid balance. This is
especially true in the case of cirrhosis but is also seen in earlier
stages. Watch for sodium added to canned
goods and prepackaged foods. One ounce
of corn flakes contains 350 mg of sodium; one ounce of grated parmesan cheese -
528mg of sodium; one cup of chicken noodle soup - 1108 mg of sodium; and one
teaspoon of table salt - 2,325 mg of sodium! Also watch your salt intake when
you are eating out in restaurants.
Niacin
can be really hard on the liver. It
should be avoided by people with chronic liver disease. This is Vitamin B3. It is also available in a form that you can
take and that is called niacinamide.
You
will need to check your multivitamin for the inclusion of iron because it is commonly
added. It is possible to get a multivitamin without iron however I have not
been able to find a multivitamin without vitamin A, beta carotene and iron.
Keep an eye out for niacin but it is not usually in the multivitamin because it
causes flushing and itching.
The
liver cleanses the blood by metabolizing chemicals, and by neutralizing and
destroying poisonous substances. This means that you have to be very careful
about anything then goes into your mouth.
This includes herbal medicines and prescriptions.
People
often make the mistake in believing that natural is good when in fact there are
many natural products that are harmful to the liver. A basic rule of thumb
should be to consult your physician or practitioner when ever you add something
new to your regime. I'll do a separate paper based on herbs because the topic
is very big. The list of herbs that have
caused liver problems or death include valerian root, germander, asafetida,
hops, skullcap, gentian, senna fruit extracts, chaparral, mistletoe, Jin Bu
Huan and Ho-shou-wu. This list is far
from conclusive.
Prescription medications that have cause problems for people with liver disease include the diabetes drug Rezulin, Tylenol, Methotrexate, Paxil, Ibuprofen, Diclofenac and many others. If you see a drug that you're taking on this list, please do not panic. Problems usually developed with the initial doses. Never stop taking a prescription that youhave been on for awhile without seeing your doctor first.
Poor
nutrition and its effect on hepatitis C
The
Canadian Journal of Gastroenterology,
Malnutrition
frequently occurs in patients with chronic liver disease, and may influence
both short and long term clinical outcome in these patients. Therefore,
nutritional intervention may play an important role in the management of
chronic liver disease patients.
What
Might Help- The Antioxidant Cocktail
Antioxidants protect cells from damage by free
radicals. They work against the process
of oxidation which is the robbing of electrons from substances. The following antioxidants are either
decreased in hepatitis c or offer protection to the liver. Alpha lipoic acid, selenium (zinc),
folic acid, Vitamin C, Vitamin E, milk thistle, N-Acetyl Cysteine (NAC),
Coenzyme Q and (B12).
I would consider choosing from this group if
you’re strapped for cash. These
antioxidants work synergically ie
together they have more power than individually.
Selenium
This antioxidant is lowered in liver disease and
is dependent on zinc.
NAC
(N-acetyl cysteine)
N-acetyl cysteine is a powerful antioxidant and a
stable form of glutathione. Glutathione
is very active in liver detoxification. It is an important free radical
deactivator offering protection against cataract formation, as well as immune
enhancement, liver protection, cancer protection and heavy metal
detoxification.
NAC is given intravenously in hospitals to
patients with Tylenol overdoses. Tylenol
destroys the liver in overdoses and immediate administration of NAC may help.
Immune
responses are mediated by small chemicals like cytokines and lymphokines. One
of the best researched is the amino acid cysteine. The activation and
proliferation of T cells normally requires oxidizing substances such as
superoxide and hydrogen peroxide, and
lymphocytes contain a limited amount of reducing substances such as
cysteine. Lymphocytes can utilize cysteine for NAC for glutathione production.
For
a maximal absorption NAC is taken on an
empty stomach. Do not take with garlic.
Please see the article by A.S.
Gissen on NAC for more info.
A word of caution: Some people have experienced nausea with this
product.
Alpha
Lipoic Acid
Alpha lipoic acid is found in potatoes, carrots,
beets, yams, kohlrabi and others. It is typically reduced in liver disease. It
is a potent supplier of glutathione and has been shown to increase immune
function.
It facilitates the metabolism of glucose to
energy. It has been very successful in
the treatment of diabetes and diabetic neuropathies. It is helpful in neurogenetive disorders.
It has also been found to be protective in the
case of cataracts.
Neuropathy from the Combo? Try alpha lipoic acid
to reduce symptoms of tingling and numbness in the hands and feet.
Lipoic acid also helps with bruising along with
vitamin c.
Zinc
Zinc is necessary for the metabolism of
selenium. Both selenium and zinc found
to be reduced in patients with hepatitis c.
Coenzyme
Q
Coenzyme Q is an integral part of the mitochondria
which is the energy producing unit in your cells. Many hepc’ers find an increase in energy when
they take this supplement. A common
dosage would be 60 mg per day.
Folic
Acid
Folic acid is typically reduced in people with
hepatitis c. A decrease in folate has been linked to mental confusion,
depression and fatigue.
Special caution: High doses of folate can cause a decrease in
zinc absorption.
Too much methionine can cause a decrease in
folate.
Vitamin
C
J. Clin. Invest. Volume 102, Number 1, July 1998, 67-71, Dietary Supplement with Vitamin C Prevents Nitrate Tolerance, Eberhard Bassenge, Nelli Fink, Mikhail Skatchkov, and Bruno Fink, Institute of Applied Physiology, University of Freiburg, Hermann-Herder-Str 7, D-79104 Freiburg, Germany
In this study they concluded
that it is possible to increase platelets and decrease platelet breakdown by
supplementation with vitamin C. Vitamin C also helps with bruising.
A decrease in vitamin c has been seen in
Porphyria Cutanea Tarda (PCT), a skin
conditions seen in people with hepatitis c and associated with access iron.
Special caution: people
that have a tendency to kidney stones should not take high doses of vitamin c.
Superdioxide
Mutase
Superoxide
dismutase in patients with chronic hepatitis C virus infection was found to be
decreased in the liver. A study
suggested that it could be this oxidative stress that is initiating a
fibrogenesis cascade in the liver of patients with chronic hepatitis C.
A
pilot study of the effects of d-alpha-tocopherol on hepatic stellate cell
activation
in chronic hepatitis. C. Houglum K, Venkataramani A, Lyche K, Chojkier M.
Gastroenterology, 1997;113:1069-1073.
Milk
Thistle
Milk thistle is a powerful antioxidant. In addition to this it has antifibrotic
effects ie it can slow the scarring within the liver. There are many scientific
papers that support this finding.
A word of caution:
some people find that milk thistle causes nausea and discomfort and cannot take
it for this reason.
B12
Problems with malabsorption for possible. B12
is stored in the liver and problems with this can lead to fatigue. B12
is necessary for some energy metabolism and some patients with hepatitis c have
noted an increase in energy when they take this. It is possible to get B12shots
from your doctor however recent studies have shown that sublingual B12
has about the same absorption as the injection. You can get sublingual B12
from the health food store 100 for $10.00.
These lozenges should be placed under the tongue and allowed to slowly
dissolve. The B12 is absorbed
through the sublingual vein under your tongue directly into your blood.
B12 has been linked to immune
response, mild dementia, and peripheral neuropathy.
Sleep
As simple as it sounds, your best medication as
sleep. It is critical for people with
hepatitis c to get enough rest. That
means rest whenever you feel tired or
try scheduling an afternoon nap. It
doesn't have to be a long time. 20
minutes often is enough but take more if you feel you need it.
We live in a society where we have learned to
push past fatigue and to ignore how we feel.
You have to train yourself to learn to listen. You can get much more done this way even if
it takes a little bit longer. And at the
end of the day you might not feel so bad.
I have seen a surprising number of people that
suffer from sleep disorders. Many of
them suffer from restless leg syndrome or periodically movement disorder. While there has been no association with
these 2 conditions to hepatitis c, I can't help but wonder if there's isn't a
relationship. If your sleep patterns are severely disrupted, consider asking
your family doctor for a referral to the UBC Sleep Disorders Clinic. A good part of your fatigue could stem from
lack of restful sleep.
Essential
Fatty Acids
The
primary omega-3 oil is called alpha-linolenic acid (
In
addition, the study in Scand J Gastroenterol 1997 Apr;32(4):350-356 called "Steatosis and collagen content
in experimental liver cirrhosis are affected by dietary monounsaturated and
polyunsaturated fatty acids" by Fernandez MI, Torres MI, Gil A, Rios A found that fibrosis and steatosis may be
influenced by dietary fat, and monounsaturated fat appears to influence
favorably the histologic recovery of the damaged liver.
SAMe
SAMe
has been shown to reduce ALT and cholesterol.
The
reason that people want to add methionine to their diets is because it
increases glutathione, a powerful antioxidant and liver detoxifier. Methionine
gets turned into SAMe by an enzyme called SAMe synthetase. People with cirrhosis and liver disease often
have an impaired synthestase so adding methionine won’t increase the SAMe and
therefore no subsequent increase in glutathione. Taking the supplement bypasses the problem.
Some
people have noticed nausea when they take SAMe.
It is possible to get an enteric coated form. This prevents the SAMe
from dissolving in the stomach and the resulting nausea. Nature Made makes this product. You can call them to ask questions about SAMe
at 1-888-898-1151 or visit their website at:
www.naturemade.com
Special caution: Too much methionine can cause a decrease in folate.
by
Darlene Morrow, BSc
Methionine
has been recommended to people with HCV as a liver protectant particularly in
conjunction with tylenol (500mg twice a day). While it is generally accepted
that methionine is a liver protectant, the evidence is not conclusive as to the
recommended dosage and possible to side effects. Extreme caution is
necessary in individuals with severe liver disease because drugs/substances are
processed in the liver. The effects of Hepatitis C and liver disease vary
from individual to individual. The extent of damage and your particular
condition (fibrosis, cirrhosis, etc.) will all have a bearing on your body's
ability to deal with outside substances. The following excerpt demonstrates the
possible dangers of self medicating. We strongly recommend that all supplements
be approved for your use by your physician.
Please keep in mind when reading this article that the suggested dosage of methionine was 2 x 500mg which is equal to 1g.
Should
Methionine Be Added to Paracetamol (Tylenol) Formulations? - Caution in
Patients with Liver Disease!
Reprinted
with permission from [Drugs & Ther Perspect 10(11): 11-13, 1997. (c) 1997
Adis International Limited]
source:
http://www.medscape.com/adis/DTP/1997/v10.n11/dtp1011.04/dtp1011.04.html
Adverse effects associated with methionine include nausea, vomiting, drowsiness and irritability. [8] Moreover, methionine should be used with caution in patients with severe liver disease as this agent may aggravate hepatic damage and this drug should not be used in patients with acidosis. [8] Although methionine (an amino acid) is an essential dietary constituent, studies have shown that methionine may cause reduced serum folate levels, leucocytosis, changes in serum pH and potassium and increased urinary calcium excretion when given at dosages of 8 to 13.9 g/day for 4 to 5 days. Moreover, functional psychoses have been seen in schizophrenic patients receiving higher dosages of 10 to 20 g/day for 2 weeks, and single doses of 8g have precipitated hepatic encephalopathy in patients with cirrhosis. [3] Although there is no evidence in humans, animal studies indicate that methionine may have adverse effects on the cardiovascular and coagulation systems. [3,4]
References:
3.Jones
AL, Hayes PC, Proudfoot AT, et al. Should methionine be added to every paracetamol
tablet? No: the risks are not well enough known. BMJ 1997 Aug 2; 315: 301-4
4.Krenzelok
EP. Should methionine be added to every paracetamol tablet? Yes: but perhaps
only in developing countries. BMJ 1997 Aug 2; 315: 303-4
8.Martindale.
The Extra Pharmacopoeia, 31st ed.
Studies
have shown that people with hepatitis c have a decrease in this antioxidant. It
is possible that vitamin E can be a useful adjunct to interferon therapy. 1 study found that the addition of vitamin E
Some studies have confirmed a lowering in the liver enzymes in response to
antioxidant supplementation.
Furthermore patients with rheumatoid arthritis were found to be
deficient in Vitamin E and it may be possible that supplementation could help
reduce the aches and pains that are common in hepatitis c.
Vitamin
E has been associated with a decrease in fibrogenesis (the scarring). It is
also effective in reducing cholesterol and in increasing T-cell function.
Fragility of red blood cells (RBCs) has
been associated with low vitamin E.
Vitamin
E is found in a couple of different forms and the effectiveness of the forms
may differ. The best thing to do is to
buy the mixed vitamin E.
Vitamin E absorption is influenced by low zinc.
Special note: Dosages of 800 IU coupled with 1,000 mg of vitamin C were found to relieve the hemolytic anemia associated with combination therapy. it may also help with the peripheral neuropathy.
Caution: Sudden supplementation in unaccustomed individuals may raise blood pressure. Vitamin E also increases the effect of cyclosporine and dosage the need to be monitored.
SKIN PROBLEMS
Topical
vitamin e as been shown to help with some skin problems. I would also recommend
that you try a product called Bag Balm.
You get it from Buckerfield's or a horse place. Try phoning the
pharmacies too. Sue was a real great detective and tracked down the
product at Krupp’s Pharmacy on
Weight
loss is common in hepatitis c and often stems from the constant nausea. Something that I have found very helpful is
ginger. Now there are several ways of
getting the ginger. First of all you can
buy the standardized organic ginger in 500 mg capsules at the health food
store. Take 3 capsules at the first sign of nausea. The ginger has a wonderful
effect and it is also an appetite stimulant and an anti-inflammatory. Many people enjoy ginger tea. Grate a one
inch piece of ginger and place it in a tea strainer. Add boiling water and
cover for 5 minutes. You can sip this drink throughout the day.
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