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alcohol and interferon
by joel6483, May 25, 2008 08:31PM
So, why can't you drink if youre going through treatment? Does it make you sick? Or is it because youre doing damage to your liver
Yesterday I didn't drink enough water. I had a few beers, though its frown upon, and I woke up today with a fever a feeling really sick. I slept until 3 or 4 in the afternoon. Everything was sore and achey (achy)...
Feedback please
Yesterday I didn't drink enough water. I had a few beers, though its frown upon, and I woke up today with a fever a feeling really sick. I slept until 3 or 4 in the afternoon. Everything was sore and achey (achy)...
Feedback please
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Second of all alcohol will speed up the death of your liver
Third of all if your doc knew that you were going to drink he / she probably would not treat you.
fourth of all most if not all the people on this forum want to get well & LIVE
fifth of all if you need a liver transplant and drink, you will not get one and die
Those are the cold hard facts as I see it,
GSDgirl
It gets to be kinda hard injecting yourself with one hand and while having a beer in the other!..
Seriously, If you don't understand why you shouldn't drink at this point you probably shouldn't be starting treatment. Doing treatment is no easy task. It requires commitment and responsibility for up to and sometimes beyond a year of your life. If "I had a few beers... slept until 3 or 4 in the afternoon" is a common occurrence for you doing therapy SUCCESSFULLY is going to cause you to have to modify your lifestyle in a dramatic and fundamental way.
Of course the decision is up to you.
I wish you all the best decide.
Hector
It's fine if you want to do it but...... you are probably wasting your time treating. You should either do just one or the other.
alcohol consumption increases viral load
" " increases liver damage
" " decreases the success rate of treatment
History of alcool consumption = no chance at a transplant
Agreed; if you tell your doctor you will likely get jerked off treatment. That might be a good thing since the odds of success are slim if drink through TX.
Sorry; not much good to say about drinking while on TX or drinking with HCV. Go check out what end stage liver disease looks like; it's even less fun than TX.
There are many threads in this forum about the subject. Use the search engine and type in alcohol, HCV. This topic has come up many many times.
Good luck and I'm sorry if I came on strong. I hope you can stop drinking. Most of us genotype 1's only have about a 45% of clearing when we do everything right. To increase your chances of clearing I'd stop drinking.
best,
willy
The reason way you should'nt drink alcohol has nothing to do with throwing fuel on the fire or causing more liver damage. Although they good reasons.
Alcohol and IFN hate each other. Alcohol stops IFN from working.
Your liver has to rid itself of the alcohol before the IFN induced immune response can occur again. IFN is metabolised in your Liver.
CS
CS
CS...... I'm not sure what criteria it takes to be considered an "alcohol Nazi"
Near as I can see people were laying out basic (and unhappy) truths about alcohol as it pertains to TX and HCV. Those truths may be unpleasant for one who is drinking. They are decidely less unpleasant than the alternative result or outcomes of 1) drinking while one has HCV or 2) attempting to drink alcohol while on treatment. (IMHO)
I suspect that Joel asked the question already partially knowing the answer. The folks who took time out to give him an answer to his question don't deserve your judgement or labeling. I saw no judgement in my or the other posts; I did see people trying to dissuade him from the practice of drinking while on TX through providing him the reasons. It sounds as if his liver and general well being also weighed in on the subject the day after. : )
I'm not sure which is the cruelest; to try to deter people from drinking or to offer somesome kind of "well, a little might not hurt" sort of reply that could serve as a means of enabling a practice that is neither good for the liver or for treatment.
Best,
Willy
Willy- Alcohol is about the worst thing you can expose yourself to while having HCV
---------------------------------------
Not true. Heavy alcohol consumption is.
Whether anyone likes to admit it or not there is a safe alcohol consumption limit.
What that limit is may be debateable, but there will be an amount that we all can drink that does not progress or further liver damage.
To make a blanket statement that any and all alcohol consumption = cirrhosis is simply misleading.
I will admit that zero alcohol is a safe limit but so is 1 or 2 drinks a month for someone who is F2 or less.
I'm not sure which is the cruelest; to try to deter people from drinking or to offer somesome kind of "well, a little might not hurt" sort of reply that could serve as a means of enabling a practice that is neither good for the liver or for treatment.
A little doesn’t hurt full stop. The only question is how much is a little.
It is easier to say no alcohol with HCV but that doesn’t make it true.
Where is the evidence.
Joel asked -So, why can't you drink if youre going through treatment? Does it make you sick? Or is it because youre doing damage to your liver”
The reason you should not drink on Tx is because it reduces your SVR odds and by quite a lot. Its not because it damages your liver but because it slows down Interferon absorption.
See your liver as Male. It sequentially multitasks and has to process the alcohol before it goes back to processing the IFN.
Saying anything else is conjecture.
CS
Trish
http://pubs.niaaa.nih.gov/publications/arh27-3/232-239.htm
http://www.webmd.com/content/article/4/1680_51403
http://www.janis7hepc.com/faq_page_five.htm
http://www.hepctrust.org.uk/Wellness/caring-for-yourself/
http://www.phac-aspc.gc.ca/hepc/pubs/nc-hcp-sn-is/practice_e.html
Alcohol is the most commonly abused toxic substances that heppers should avoid. I'm speaking generally and you are splitting infinitives. I don't see any professionals quantifying use of alcohol. You seem to feel comfortable suggesting that there is a range which is safe.
Recommending people don't drink alcohol if they have HCV or are on treatment is well established, documented, and a very popular opinion of medical professionals; not only "alcohol Nazis". My opinion..... but since people don't reliably report how many drinks they actually consume (especially over the years) the data is often imprecise. People don't always progress at the same rate for a variety of reasons; daily dosage, age, sex, weight, genetics, other co-factors (use of pot, diet), etc.
It is difficult to recommend an acceptable amount since it will vary from person to person. I think the reason you see the tendency for professionals simply nix any use. It's one thing they know that's safe. I'm inclined to do the same as the professionals. It's hardly an uncommon reply; rather it's nearly the rule. I've provided a few links which support my reply.
To round out the data we supply people who ask such questions it would be great to see some links which supply the "allowable number" of drinks we can imbibe. That would be useful for the next person who asks at MedHelp. ; ) I personally feel that it's a slippery slope to suggest an allowable range when we (generally speaking) are not doctors, may not have any medical credentials, or specific medical information about the person asking the question. I feel that it's safer to err towards avoidance of alcohol. It's just my opinion.
I was aware of the connection with diminished response and SVR rates for those who drink but hadn't been aware that alcohol "stops interferon from working". I'd love to have data/ links on that since it bears so directly on this thread and many others like it in this forum.
Best,
Willy
Willy
From HepatitisAustralia
http://www.hepatitisaustralia.com/about_hepatitis/drugs.html
Should I cut down on alcohol?
There is no evidence to suggest that total abstinence from alcohol is necessary when you have hepatitis C, unless you have cirrhosis. However, it is recommended that people with hepatitis C who consume alcohol in large quantities should reduce the amount they drink, as alcohol does increase the rate of liver damage.
SonicBandaid Post
http://www.medhelp.org/forums/hepatitis/messages/46836.html
What nonsense! Sure, its BETTER if you aren't drinking and I certainly advise my patients not to drink more than 7 standard drinks per week (in fact, alcohol consumption at that level or lower is a prerequisite for funding therapy in Aus), but there is little evidence to suggest low level social alcohol consumption of this sort impairs your response to treatment in any measurable way or accelerates your liver disease (assuming you don't have an alcohol PROBLEM or alcohol related liver disease to start with. We are supposed to practice "evidence based medicine" and I would LOVE to see any evidence that getting people to be completely abstinent for 6 months prior to treating HCV with IFN/Riba makes any difference to outcome (other than the fact you unnecessarily delay therapy)
It is also not realistic. If I insisted on this, I'd wind up treating about 25% of the patients I have. The Puritans have a LOT to answer for. Several patients I currently treat also tell me that 1-2 glasses of wine (on the nights they inject, only) actually makes the side effects more tolerable.
Cheers,
Sonic
Note: SonicBandaid is a Doctor who has practiced in the US and now lives in Aust.
Or at least did last year.
How much more do you want.
I would like some studies that back up the no alcohol claim and there aint too many of them.
Wanna play study wars
CS
I have a little story though. My step mom has hep c. Dx in the 90ies. She contracted it through a blood transfusion in 87. Anyway, she has had many biopsies, each time it is A1 F1. She does not want to treat. Being French, she has her little glass of red wine every day and might have some kind of aperitif in the evening. The results of her biopsy haven't budged in years and she is 70 now. She's had all kinds of other operations and chemotherapy due to breast cancer, tumors in the stomach...
I don't know what to think....
Marcia
http://www.hepatitisaustralia.com/about_hepatitis/drugs.html
"There is a higher risk of developing liver disease, including cirrhosis, if you have hepatitis C and drink alcohol. Alcohol is also likely to affect your response to treatment, making treatment less effective."
The first one that I provided was;
http://pubs.niaaa.nih.gov/publications/arh27-3/232-239.htm
"Patients infected with the hepatitis C virus (HCV) who drink heavily are likely to suffer more severe liver injury, promoting disease progression to cirrhosis and increasing their risk for liver cancer. Some research, although not conclusive, suggests that even moderate drinking may spur liver damage in HCV–infected patients".
Dr Schiff is one of this nations leading hepatologists. This link comes from a branch of the NIH. I consider both good sources of information.
No point in quibbling over whether you can drink. I provided information which suggested it was a bad idea. I backed it up with solid references. If you want to provide advice to people that they can drink and drink safely while having HCV or on TX (such as with Sonics post) ...then by all means .....go for it. Post it. : )
I look forward to seeing your future posts on the subject.
best,
Willy
I hope that there will come a time that we all get cured and the issue is less thorny.
best,
Willy
Best,
Marcia
The reasons you SHOULD drink on treatment:
I want treatment to fail treatment so I'll drink and take away all efficacy of the meds! YAY!
I want to die in End Stage Liver Disease, even though I could have prevented it - those Pabst Blue Ribbons were just too tempting to make it worth it! YAY!
I want to show everyone just how weak I am and that I don't give a whit about their lives or pain either! MORE YAY!
Just my personal opinion but I'm tired to DEATH of this stupid question. It's nothing different than someone with lung cancer asking ok if it's ok to cut down to 2 packs of Lucky's a day from 4. I mean how much COMMON SENSE do people need to have to realize the OBVIOUS?
I don't need to know the technical reasons, its doctor's orders. I'm not a child or an idiot and I'm not about to trash 48 weeks of treatment hell just because I haven't heard a convincing reason not to introduce poison into my system. I'm an adult, paying for the best professional care and advice available.
Its doctors orders, not open for debate. NO ALCOHOL
Shoot if I put a needle in my eye and it hurts like hell I won't be posting the next day help I put a needle in my eye I can't believe it but it hurt why did it hurt like that?
hahahahaha.
(I'm glad that YOU get it.........after all we can only worry about the people who do...the others aren't going to be around to bug us that long - after 3+ years on this forum, it's pretty easy to tell who is serious and who is not and I just don't have the patience for the "I want to drink and only do 12 weeks of treatment what are my chances?" people.
Common sense is a MUCh more rare thing than I EVER thought it really was!
(Hey you aren't Trinity because of the Matrix are you? A friend of mine met Keanu Reeves two weeks ago and just told me and it made me think of you and wonder...of course..I keep forgetting to ask you!)
Marcia
it's amazing to think that anyone would want to come in an post garbage just to post garbage but it happens all the time. Especially in the summer months and on vacation from school days. Yowza it can get bad - and hard to ignore the little twirps when it happens.
Can you imagine going over to a cancer website and saying half the things we get here? Like hey I have lung cancer and smoke Marlboro's but I want to know if smoking Newports is better for me now?
OK yeah.............. ;)
Sure, its BETTER if you aren't drinking and I certainly advise my patients not to drink more than 7 standard drinks per week
but there is little evidence to suggest low level social alcohol consumption of this sort impairs your response to treatment in any measurable way or accelerates your liver disease (assuming you don't have an alcohol PROBLEM or alcohol related liver disease to start with.
Now I am staying out of this as the guy who started the thead hasnt made another Post.
There is no point thowing statements back at each other.
nygirl7
Your statements on alcohol arent backed backed by evidence. Just Puritantical nonsense. Of cause its better not to drink but you are drawing a long bow saying all and any alcohol causes problems. Find a study that states 10g or less of alcohol is a problem. There are heaps that say >40g is a problem.
Willy
HepatitisAustralia is a reputable site and while not exacltly Medical does have acces to Medical knowledge. If the evidence in Aust or anywhere in the world supported no alcohol they would change what they say.
I would like to know whether his patients having a wine or 2 on shot night svr-ed.
Thats taking a risk.
CS
CS
I more and more think that the 12step movement is spreading a lot of stupidity world wide.
And theirs influence on medical care is much bigger than anyone can imagine.
So cocksparrow I really like that you are reacting to stupidity bunkum argumentation.
ca
People just state the facts and leave your personal bias to yourself, it lends much much more crediblity to this great site.
Alcohol, Tobacco, and Cannabis All May Promote Liver Disease Progression in People with Chronic Hepatitis C
By Liz Highleyman
An estimated 25% or so of people with chronic hepatitis C go on to develop severe outcomes such as liver cirrhosis or hepatocellular carcinoma (liver cancer). Numerous host, viral, and environmental factors contribute to this variable rate of disease progression, not all of which are fully understood.
In the April 2008 Journal of Hepatology, 3 hepatology experts reviewed environmental factors associated with accelerated liver fibrosis progression in chronic hepatitis C patients. They noted than these factors have been investigated in order to improve clinical outcomes, especially for "difficult-to-treat" patients who tend to respond poorly to interferon-based therapy.
-----------------------------------------------------(denotes emphasis-willy)
Over the past decade, the authors wrote, "several studies have shown that a combination of HCV infection and high levels of alcohol abuse results in synergistic acceleration of liver fibrogenesis." In addition, they added, more recent data indicate that even light alcohol consumption may also worsen fibrosis progression.
-------------------------------------------------------
Some studies have suggested that tobacco smoking may enhance histological activity in chronic hepatitis C patients, thereby promoting fibrosis progression, although this has been less extensively studied than alcohol. One recent study suggested that enhanced fibrosis associated with cigarette smoking may be due to cytokine changes triggered by low oxygen levels.
Finally, the authors continued, cannabis use is increasingly emerging as a novel factor linked to liver disease progression in patients with chronic hepatitis C. As previously reported, studies by co-author Christophe Hezode have shown that regular cannabis smoking is an independent predictor of both fibrosis and steatosis severity in HCV-infected patients.
In addition, they added, "experimental studies have shown that cannabinoid CB1 receptors enhance liver fibrogenesis and steatogenesis by distinct mechanisms, therefore strongly supporting epidemiological findings."
In conclusion, the authors wrote, "[P]atients should be informed of the deleterious impact of alcohol, tobacco and cannabis use, and should be offered appropriate support
-------------------------------------------------------------------------------------------------------------------------------to achieve abstinence." (Uh oh...there's that word again; more Nazi's; French Nazi's ) ; ) Willy
-----------------------------------------------------------------------------------------------------------------------
Department of Hepatology and Gastroenterology, INSERM U841, Groupe Hospitalier Henri Mondor-Albert Chenevier, Créteil F-94000, France; AP-HP, Groupe Hospitalier Henri Mondor-Albert Chenevier, Service d'Hépatologie et de Gastroentérologie, Créteil F-94000, France; Université Paris 12, Faculté de Médecine, Créteil F-94000, France.
3/28/08
Reference
A Mallat, C Hezode, and S Lotersztajn. Environmental factors as disease accelerators during chronic hepatitis C. Journal of Hepatology 48(4): 657-665. April 2008.
----------------------------------------
A bit more commentary; just my opinion.
The sources that I've quoted are real, CURRENT, and by leading hepatologists. It is valid to warn people not to use alcohol. The dangers are well documented.
NYgirl makes a valid point with her analogy about smoking. As people with HCV we are already, by definition, a group with increased risk of liver disease, extra-hepatitic diseases and co-morbidities. Unless we are cured..... every year which we live we will experience increased damage as our immune system weakens with age. Vertex has provided data showing that new studies show that most everyone with untreated HCV will reach cirrhosis if they live long enough. The old saw about people "dying with HCV, not from HCV" was based on a snapshot of the population after 20 years. What happens to people who live 30, 40, 50 years after infection?
We ALREADY have liver disease. Most of us already have varying amounts of liver damage. It is well documented that immune response diminishes with age. I believe that I've read that the median of our age group is about 50 years. Proposing that "moderate" drinking is safe (I've provided you 2 links from respected sources saying it may not be) is irresponsible. Maybe it's what you want to believe. There is evidence to the contrary.
Keep in mind also...... the population of the of the HCV infected includes many people with substance abuse issues; it's part of our demographic. It's the way that the largest portion of our demographic was infected (seems that I've seen 60% due to IV use, and HCV infection is strongly associated with higher numbers of alcohol users). Giving people reason to believe they can drink with impunity while they have HCV is reprehensible. In a group of 1000 people who might follow your beliefs and posts you would almost certainly be shortening some peoples lives and quality of life. My belief is that if people were to follow the non-drinkers advice would experience longer lives than the normal hepper. Whose advice is the safest to follow?
Willy
Respectfully, I don't think NY girl's analogy quite hits the mark. 2 Packs of Luckys' from 4 Packs for a cancer patient would be like a half a quart of 100 proof a day from a full quart for a cirrhosis patient. Contrast that with 4 beers once for a non-cirrhotic. I don't think hyperbole helps the discussion.
Why not to drink on tx? Among other reasons because it suppresses the very immune response you're trying to stimulate with the drugs. We use rescue drugs, pre-dosing, extending, fat-eating and all kinds of **** to try to increase our chances.... and alcohol lowers them. You shouldn't drink.
The reason you shouldn't drink at all with hepC is because of the way alcohol is metabolized. It requires an enzyme called CYP2E1. Liver damage by hepatitis C is caused by oxidative stress on the liver cell. The cytochrome that our own bodies manufacture, 2E1, actually facilitates the oxidative stress, causing the cell to kill itself through a mechanism called apoptosis.
Alcohol, acetominaphen (Tylenol), dextromethorphan (a popular cough suppressant), and a few other drugs are metabolized by 2E1. The reason why people have died from drinking alcohol and taking Tylenol is because both drugs are competing for the same enzyme, causing overdose. This enzyme, 2E1, also stops interferon from working. If you're drinking and shooting interferon, you're wasting your time.
One of the strongest inhibitors of 2E1 is a drug called Antabuse. It helps people stop drinking by denying alcohol the cytochrome it needs to metabolize, so they end up violently ill if they drink. If you've got hepC and a drinking problem, your time here on earth is probably going to be short.
2E1, whether mixed with alcohol or not, increases viral load and helps destroy liver cells. This cytochrome is also implicated in non-alcoholic fatty liver disease (NASH), so high levels of 2E1 can be present in people who don't drink.
If you're having a tough time abstaining, ask your doctor about Antabuse. It's a potent 2E1 inhibitor that will not only help you stop drinking. It might even help your liver. There have been some individual cases of liver toxicity with this drug, but overall, Antabuse is considered safe for the HCV community by the NIH.
Good to see everyone. Oh yeah. I should mention. I've sort of started blogging again, and my OCD has led me down a new road.
http://www.mkandrew.com/page1.html
.
And it doesent matter if the poster is an imposter.
The issue here in my opinion is, like goofy said in a very gentle and fine way.
"Its also resonable to ask why not", if your not allowed to ask we might very well have a nazi issu here.( after the comma my reflection not goofys)
ca.
Magnum
Comeagain; I agree that it's fine (and important) to ask the question. It's also fine to get scolded when you mess up. This is about someones life or the success of their TX. The disagreement which followed comes from downplaying the importance of alcohol as it pertains to HCV or TX. We also have to think about the person....or 100 people that follow who read the thread, but who never post. What do they learn from this thread?
Dad, I think that NYgirls analogy was about us already being damaged and attempting to moderate our HCV with half measures. I also personally believe that the poster was real. They knew that drinking was "frowned upon" but drank anyway. It had that ring of authenticity when they reported that they drank "a few beers", the actual amount being either deliberately unmentioned or perhaps unknown. Sure sounded real to me.
MK; nice to see you here. I miss my drinking too. I HAVE to miss it for awhile until I clear up this virus, at least that's my belief. I don't see drinking as a moral issue. I could care less if people chose to drink when they have HCV. I have a different standard for trying to provide people on a bulletin board information about HCV or TX and in this case as it pertains to drinking. In this thread I'm afraid that newbies could get the idea that you could drink..... now.....what was it?;
" I certainly advise my patients not to drink more than 7 standard drinks per week"
Or the AU that site offered this;
http://www.hepatitisaustralia.com/about_hepatitis/drugs.html
"Should I cut down on alcohol?
There is no evidence to suggest that total abstinence from alcohol is necessary when you have hepatitis C, unless you have cirrhosis."
When you combine the two links I suppose it means that we can drink no more than 7 drinks per week until we develop cirrhosis..... but then we should stop. : )
Can you understand why I reply to this? (although I think I'm about done. : ))
Willy
It turns into compounds that you wouldn't drink...like fingernail polish remover and paint thinner equivalents.
would you drink those? No. but yet, every time you do drink alcohol that's what your liver must face...and not only are these toxic, but they stop the liver from other important proceses, change glycogen metabolism, force the laying down of fat storage in the liver, and slow the healing process to the point where some studies suggest rates of fibrosis 10 times greater in drinkers than non-drinkers.
since you are trying to get the virus to stop replicating, AND to regain healthy liver tissue, slowing or halting the spread of fibrosis, why would you want to do the thing most likely to undo all that good being done?
the chemo itself is toxic...often this is not explained to treaters...in fact the chemo can make your liver worse.
It doesn't happen often...but on the print outs you will see listed amongst the serious possible side effects liver failure. This is seen more in late stages, but not unheard of and as we don't know all the factor that cause it, such as immune response etc...the one factor we do know for certain can bring it on is certainly one to avoid..
therefore do every thing possible to keep food, herbs, drugs and alcohol known to be toxic from your diet and you give yourself the best chance to live. Give yourself time to heal and get well first....then perhaps there will be times for a little toast, You will certainly improve your long term odds if you take the conservative approach now.
mb.
gerterdone
SonicBandaid - would like to see him post again as well as HR
but there are folks who get so hyper on Riba that they don't sleep at all for days, I'm one of them. They say it has to do with the same gene that is predictive of bipolar/manic depressive and the like. Basically, there are genes that tell your brain to make seretonin in the daytime, and melatonin at night. If you have a weak gene, or family history, etc//
and you add RIBA to that, your brain cannot keep up with the demand for chemicals.
"this drug then turns grown men/former marines into pools of tears" to quote my clinician.
Since I use no stimulants or caffiene products, it became quickly apparent the Riba was the culprit. And, after not sleeping, once for 3 entire days and nights, and once for FOUR..you do what you have to do.
At that point I opted for the drug known to be the least harmful to the liver.
and opted for the smallest dose.
Eo have chosen alcohol, would have been to choose the drug known to be most harmful to the liver, and the point is, I'm trying to do the least harm, and not undo any progress being made.
If the brain stops making seretonin, people cannot cope with work, life, leaving the house, or anything they normally do that involves ANY stress...
likewise if your brain stops making melatonin at night..you can literally die of sleep deprivation...
so I think the answer here is to find what does the least harm, in a perfect world that would be to use no substance at all to help...just the power of prayer....but we are not in a perfect world....yet.
MB
In the majority of cases, neither of those are required or desired. In the smaller number of cases, I'm not going to go so far as to make someone feel bad at the expense of their treatment.
Personally, if someone was going to ask my personal recommendation, in the strictest sense of the word, I would say that best case scenario is that persons with HCV shouldn't drink, persons on treatment definitely shouldn't drink and nobody with HCV should toke. That's in the strictest sense of the word.
While waiting for treatment, I had the odd drink. It helped. Not because I'm anywhere close to being an alcoholic or anything other than a very occasional social drinker. It just simply took the edge off once in a blue moon to have my scotch.. and even over time that virtually disappeared as my liver simply didn't like it, even though I'm early stage liver damage.
Least amount of harm is what gets you through the best sometimes. And sometimes, for that odd person, the occasional drink just might do it .. even though I wish that wasn't required and when I've spoken out against it myself on treatment. It's all about where's the difference between coping with treatment or not.
Do we really think it's good for us to go on AD's and then develop a dependency and have to wean ourselves off of it? But we do it. (Well not me, not yet and here's hoping.) Heppers in general do what they gotta do to get through treatment on top of doing what's the absolute best for your health. There's a balance.
It's not a one size fits all, even though it's a one size fits most when it comes to this topic, in my personal opinion. Maybe that's controversial, that's how I see it.
Trish
I WILL not drink on Treatment..that would be foolish in my opinion. I will do everything I can to take care of myself and beat this.. I would like to think someday I can have a glass of wine again without all the worry.
The other thing I would like to say is I wish everyone would respect others opinions and not be so mean to each other.. we are all in this together...
I actually think that CockSparrow and I may agree closer than we let made clear. Both of us know that too much is bad for you and a teeny amount won't likely hurt people unless they are stage 3 or 4. What we were arguing about is that area in the middle and...... it's WORTH arguing about too. That is where many heppers could end up; modifying their behavior and going with it they read that it's alright ( I mean... I would IF I believed it). I know that CS cares about heppers, TX, quality of life and all that. Likewise for me and I hope ya'll don't think I hate the drink or the drinker.
It's also a sometimes emotional debate since some of us have either lost people near to us to liver disease. We may have fellow hepper friends whose life is shattered by HCV who haven't any room for getting even a little bit worse. We may have strong feelings about people who may be risking their lives. If you've treated as some have here for an extended treatment.... you may not be too sympathetic to someone who risks the efficacy of the treatment in exchange for the drink. It's easy to let emotion enter into the discourse. Hell; it's a life threatening disease. We have our lives (or others lives) on the line. There will be emotion.
Once again, my apologies if I was over the top either to CS or to Joel.
best,
Willy
Seeing everyone having such strong opinions about alcohol and HCV is funny, in an odd sort of way. It reminds me of a post I was once involved in on whether or not the prison population should have access to HCV drugs. The bullets flew there too.
If you prefer lifestyle over longevity, drink your butt off. As for me, I prefer to stay around and annoy people for as long as I can.
-----------------------------------------------------------------------------------------------------------------------------
I think you're blowing out of proportion the points that people are making and your interpretation is almost harmful. I haven't seen anyone suggest that people should or can "drink their butt off" on HCV or treatment. Nor anyone suggesting that lifestyle trumps longevity. My own reference is to getting through treatment successfully. The saying goes " you don't kill the virus AND kill the patient" when it comes to managing treatment properly so that it doesn't do you more damage than it needs to. I think the same thing applies here. "You don't kill treatment and therefore kill the patient". No alcohol on treatment. That's what I'd strongly recommend. If someone truly can't make it through without the occasional drink, then I say get through the damn treatment and take the occasional drink. They are even starting to change their minds about treating people who can't stop drinking with some understanding that at least you can try curing one disease if you can't cure the other..rather than curing neither and exacerbating both.
and this class of drugs is full of many P450 inhibitors, which may actually help the interferon work. My problem is that I cannot take SSRI drugs because of side effects, so I was taking Wellbutrin, a P450 inducer.
I will start treatment in July, I am now taking Welbutrin 300mg as a precaution...is there a problem with this AD? I am not sure I understand what you are saying,
If you only drink small amounts for a short period do you believe that in itself will cause more damage...
I guess my questions is when I go to Italy and I have small drinks of wine will that really be bad...
Type 2B 2 grade
It is certainly safe for people to be out and around the city exposed to all kinds of germs; the imune system just fights the bugs off and there is no harm to the body. However, if a person does not have a competent imune system, then these mundane exposures can result in exotic life-threatining infections that a normal person would never contract, though exposed. A person with an impaired imune system needs to take extra precautions.
So, having a liver that is impaired by a lethal viral infection, and likely with disease (fibrosis, cirrhosis), why would you want to take a chance with exposing yourself to toxins that clearly can impair the liver? It is a no-brainer for me.
Having said that, everyone chooses for themselves, and I would not interfere. There may well be a level of alcohol consumption that will not hurt a person with HCV. I just hope that nobody would use that as an excuse and continue drinking, losing sight of the original limits, exceeding them until they find themselves, at last with ESLD.
It's your liver and your life. Just don't make stupid decisions. First thing my Hep doc told me was NO ACOHOL, NONE. He told me this several times. It seemed pretty important to him, though I know he has no moral ax to grind on the subject. Neither do I and I object to being labeled a Puritan or an Alcohol Nazi because I believe that drinking is harmful to the liver.
I have a new liver, thanks to a deceased donor and a competent team of surgeons. The surgeon and possibly the donor would probably want to take it back if I started drinking now, and who could blame them?
Sorry if I got a little heavy there; it kind of touched on a sore subject when I started thinking/posting about it. :)
btw; the original poster (who was it?) really stirred it up here, no? Maybe that was intended. IDK.
I happen to agree personally with the point of view of don't drink while on treatment, which is the only opinion I'm dealing with here and which is what the original poster was asking about. I have come out strongly on that topic to others who are on treatment. To the poster here, I was astonished at the lack of knowledge on this subject but more concerned for what kind of medical care he's getting if he's on treatment and not aware of the harm that alcohol can do while on HCV, let alone on treatment.
However, this thread went in a certain direction and the one point that I felt is lost ... is that sometimes we're talking to people with drinking problems. And sometimes we're talking to people who are having trouble coping with treatment because of that. And sometimes, on those rare occasions, maybe we need to step outside of the box. I still see it as similar to people being on AD's. Just the other day, one of my treatment buddies was sharing with me that one of the guys in his support groups is on AD's to get him through, he knows he's potentially developing an addiction and, as I have seen posted here before, he's decided he'll deal with the addiction when he's done treatment...what he needs is to GET through treatment.
I guess that's incredibly unconventional, to think that the lesser of two evils is to have the occasional drink during treatment if that's the difference between making it through treatment or not. And that is the circumstance I'm referring to. I'm not talking about people who simply want the excuse to drink. My point is narrow and only directed at those who wouldn't get through treatment without the OCCASIONAL drink.
Anyway...I'll leave it at that. I think that narrow point gets lost in the emotion of this topic and it's not really worth me beating any kind of drum on it. In the greater sense, I concur with the consensus that not drinking while on HCV and while on treatment is best.
The lesser of two evils seems to be to tell people not to drink, not ever. And that IS best case scenario.
geterdone
have not taken anything Other Than the four items listed
but lets be precis here, during first tx i developed panic anxiety so i took something called atarax would have been taking valium if I`d got it.
this tx 1 valium once when I had the flue.
so I can´t throw the first stone LOL
ca
All I'm saying is that we do tend to do what we need to, to get through treatment. And on occasion, it may be unconventional. I'd rather nobody drank during treatment and I have come out strongly against it and I am strongly against it. The majority advice here applies to the great majority of people. I guess I'm talking about the kinds of people who would fall through the cracks. I'd rather see them do the unconventional and unpopular and get through treatment than not at all, assuming they're not using it as an excuse. That's it, that's all.
Trish
CS
---------------------------
No maybe about it that’s why I pulled out
I Had no intention of getting involved in a circular alcohol argument.
Now you have stirred me up.
Firstly it’s a free planet at least for those of us who live in the West. You can think and believe what you like about me. I Don’t Care, doesn’t make you right
>It's your liver and your life. Just don't make stupid decisions
---------------------------
I got no idea what I have said that could possibly make you think I make stupid decisions. Actually I can do a good stupid decision, but don’t appear to have made too many with my liver so far.
Seeing as I have been infected for 25 years and I am Grade 1 Stage 2.
>So, having a liver that is impaired by a lethal viral infection, and likely with disease (fibrosis, cirrhosis), why would you want to take a chance with exposing yourself to toxins that clearly can impair the liver? It is a no-brainer for me.
-----------------------------
Now this is what gets to me. You see I doubt there is anyone on the planet who would suggest that drinking alcohol when you have cirrhosis is a good thing. But to compare F4 with lower fibrosis stages is nonsensical to me. No way is F0/F1 or even F2 comparable to cirrhosis.
With stages lower than F2 what evidence is there that alcohol causes any problems.
Well if you are drinking high levels of alcohol then there is evidence that HepC can progress faster thru the stages. But does this faster progression occur with low level alcohol consumption.
Not a lot of evidence to suggest that is does is there.
You see I can tell the difference between fibrosis stage and level of alcohol consumption.
It is a no-brainer for me to. I can base a decision on what evidence is available.
Not on moralistic, puritanical beliefs.
>I have a new liver, thanks to a deceased donor and a competent team of surgeons. The surgeon and possibly the donor would probably want to take it back if I started drinking now, and who could blame them?
----------------------------------
Look I am sorry that you needed a transplant and am happy for you that you received one, but where in anything I said did you get the idea I would recommend a transplant patient consume alcohol.
So how should we look at HepC and Alcohol?
For me its all about Risk Management.
Whats the risk that alcohol will cause damage
Whats the likelihood that alcohol will cause damage
Whats the chance that alcohol will speed up progression
At what levels of alcohol consumption and at what Fibrosis stages do the risks become an unacceptable risk
Now for the original post
So, why can't you drink if youre going through treatment? Does it make you sick? Or is it because youre doing damage to your liver
Yesterday I didn't drink enough water. I had a few beers, though its frown upon, and I woke up today with a fever a feeling really sick. I slept until 3 or 4 in the afternoon. Everything was sore and achey (achy)...
So what should have been asked is
What is a few beers
What is your Fibrosis level
How far into treatment are you
How often do you drink
Then we could have told him whether he was taking a risk with svr or further liver damage, or not, depending on the answers. Instead he was hammered with things like Alcohol consumption=cirrhosis or death and this simply isn’t true.
Why cause it depends.
If he was a real poster with real concerns seeking answers he got pushed away.
This happens way to often here.
There is enough in the post to suggest it was a real post.
He got the symptoms of dehydration pretty close to spot on.
Did a good job of starting yet another alcohol argument though.
>Sorry if I got a little heavy there; it kind of touched on a sore subject when I started thinking/posting about it.
---------------------------------
Same here. More of a general swipe than directed at you.
This is actually a good thread with some excellent responses I hope it makes people think.
Both in the realisation that less alcohol is better especially with the higher fibrosis stages and in not hammering the zero alcohol message so damn hard.
We are probably not that far apart you know
Wish you Well
CS
CS quote; "Then we could have told him whether he was taking a risk with svr or further liver damage, or not, depending on the answers. Instead he was hammered with things like Alcohol consumption=cirrhosis or death and this simply isn’t true."
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my friend;
Only 4 people responded to Joel prior to you. Your reply in which you used the term "alcohol nazis" was reply post #5. You said "ignore" the advice that was given. Who is doing the "hammering"? ; )
The information given Joel was sound. In the interest of accuracy, not one person said that alcohol consumption = cirrhosis. The word doesn't even appear in any of the posts. If it were a question of only MY post or only my tone it would have been good to have distinguished that point.
The main points made by the first 4 replying members were generally;
Alcohol use causes a speeding of liver damage.
Alcohol avoidance is demanded pre, and during TX by doctors
Failure to comply can be a reason that doctors end treatment.
Failure to comply can negate the effectiveness of TX or threaten ones chances at SVR.
A history of alcohol abuse can prevent one from attaining a TP
......all of them true or substantially true, I think.
I'm not sure which of these concepts you believe should be ignored.
You seem to be of two minds in this thread. You argue that the advice given by the first 4 replying members should be ignored, and then you provide something very much akin to the same advice throughout this thread. On the other hand the information you posted from the 2 AUS sources are far from mild consumption for heppers (IMHO);
1) " I certainly advise my patients not to drink more than 7 standard drinks per week"
2) " There is no evidence to suggest that total abstinence from alcohol is necessary when you have hepatitis C, unless you have cirrhosis."
I would assume you are in substantial agreement with these statements since you posted them and even repeated them. These guidelines are only half of what the CDC calls "heavy drinking" for men.---2 drinks per day for men, 1 per day women is considered heavy drinking. Yes, that's for people WITHOUT liver disease.
http://www.cdc.gov/alcohol/faqs.htm
I'd also suggest that by the time one has progressed to cirrhosis it's a bit late to start taking proactive steps to slow down damage progression.......such as limiting alcohol consumption.
The vast majority of data, and current data supports the no drinking edict. And yes, if a person were to follow that principle one may have a little wriggle room. The experts recommend zero alcohol intake. I feel more comfortable recommending that than trying to provide an amount that people can drink. There is greater safety in recommending abstinence than recommending the edge on which one might surf.
Alcohol is not required for TX. Some pain medications, sleep aids, or antidepressants may be; it's a long treatment after all. Alcohol is the most widely abused drug of choice, not only in sheer quantity (number of drinks per year, decade, or in ones life ) but in frequency (# of drinks per day, per week), and use by our demographic. It may at the same time be among the worst substances to take which impact on disease progression or negatively impacting the efficacy of TX.
Yes, I agree it is an interesting and informative thread. It's good to have a little back and forth about the subject. It will be debated in future threads as well no doubt. I'm heading out of town in a day or 2 and so won't likely be posting much at all for a spell. Take care all, and CS, thanks for the lively debate. I'm fine with "agreeing to disagree".
best,
Willy
7:30 AM
To the person who asked, "Why should I start taking an antidepressant before starting treatment?" Because it takes 3-6 weeks for a typical SSRI AD to start working, and some people become depressed on IFN right away. So let's say you get six weeks in, which is the average point at which people experience major sides from Pegasys. You're six weeks into treatment, possibly with suicidal ideation, and you need an antidepressant, and the doctor knows it's going to take 3-6 weeks to start working.
Check out the package insert that comes with your interferon. The first warning listed is all about severe depression and suicidality. While it is true that some people are able to function normally on treatment, there is no way to predict what your sides will be, or how severe.
Also, I've never read anything about any so-called "addiction" to, or abuse of SSRI antidepressants. If anyone can show me hard data on addiction to an SSRI, I'll post it on my site. I've known many, many people who have done tx on an AD, achieved SVR, then successfully stopped taking the AD.
Alcohol avoidance is demanded pre, and during TX by doctors
Failure to comply can be a reason that doctors end treatment.
Failure to comply can negate the effectiveness of TX or threaten ones chances at SVR.
A history of alcohol abuse can prevent one from attaining a TP
......all of them true or substantially true, I think.
And all I am saying is where is the evidence to support this?
There isn’t much at low level alcohol consumption.
How does any of this apply to someone who is F0/F1 it doesn’t.
>A history of alcohol abuse can prevent one from attaining a TP
This line is what got to me. How does it apply to the poster?
>Alcohol avoidance is demanded pre, and during TX by doctors
Demanded by who and for what reason?
Where is the evidence that this makes any difference.
And what did it have to do with the posters question?
>Alcohol use causes a speeding of liver damage.
Does it, at what levels? For all of us at all time points in the disease.
Or is it for some of us at certain time points in the disease and at certain levels of alcohol consumption.
>2 drinks per day for men, 1 per day women is considered heavy drinking.
No its not. Its considered moderate.
The studies on Alcohol and HepC consider 4 drinks heavy and some go down to three with the odd one saying two. None of which is one is it.
Note: A standard drink or 10g of alcohol is not 1 normal strength beer at 5% apx alcohol.
Its 1 drink at around 3% alcohol.
>Alcohol is not required for TX.
Who the hell said it was?
>1) " I certainly advise my patients not to drink more than 7 standard drinks per week"
2) " There is no evidence to suggest that total abstinence from alcohol is necessary when you have hepatitis C, unless you have cirrhosis."
>I would assume you are in substantial agreement with these statements since you posted them and even repeated them.
I agree there is little or no evidence yes. Why cause there isn’t any.
>I'd also suggest that by the time one has progressed to cirrhosis it's a bit late to start taking proactive steps to slow down damage progression.......such as limiting alcohol consumption
There you go jumping to conclusions again.
Cant you see that if you are F0/F1 it is not the same as if you are F3/F4
And I agree if you are F3 then some life style changes are probably in order and not just with alcohol. But once again show me where the evidence is that an occasional drink speeds up progression to F4.
This does not mean I advocate getting P1ssed or drinking any amount when you are F3.
It does mean I am not going to crucify someone who has an occasional drink.
I will tell anyone who drinks heavily at F3 to stop or at the very least cut back to below 4 a week.
But then I would suggest that anyone at any Fibrosis stage who drinks more than 7 a weeks is taking a risk.
All of which misses the point somewhat I didn’t realise I actually said we can all go off and have up to 7 drinks a week. I was trying to point out that zero alcohol has little evidence to support it especially when you are in the lower fibrosis stages and that the poster didn’t need to take any notice of a few beers on tx meant he was going to be denied a transplant or he was going to die sooner rather than later. When all he asked was what the reasons for not drinking on tx were.
You didn’t answer that you gave him a lecture.
>The vast majority of data, and current data supports the no drinking edict.
No it doesn’t. Show me one study, just one. All the studies support no heavy drinking.
I will admit that it is probably easier to stop than to cut back. And it is definitely easier to get the message home that heavy drinking aint wise.
Everything you have said is 100% accurate if you have cirrhosis and no one is saying otherwise.
No real disagreement with you when F3 either. Below that what you are saying doesn’t make sense. I cant see how you can compare 1 drink with 10, or F1 with F4.
What would you say to this person about Alcohol during Tx.
http://www.hepcvsg“ dot “.org/hyperthermia.htm#nov
Remove the “ dot ”
Tx started April 4, 2003
January 3, 2004
We had a super day and ended it with dinner at the Cannery- we haven’t been there in years. It was wonderful. I even had a glass of wine.
January 5, 2004
Had a great birthday dinner with Mom and Joan. Lots of fun. Also had another glass of wine.
Now if any amount of drinking while on Tx is such a no no and always leads to non response and faster progression then how come this person svr-ed
Now Ok it was only 2 glasses on wine 9 months or so into Tx but hopefully this time you will get my point. Interesting Tx that link.
Just to be clear I am not saying we should drink on Tx but neither can you say that it is always harmfull. It depends on How much you drink, How often you drink and of course what your fibrosis stage is.
Anyway that it for me this is going round and round in circles.
All the Best
CS
circles!!!
ca
CS
I also remember back when SonicBandaid posted some of those things you're quoting. As I recall it was among a very long thread regarding a person that was denied treatment because they hadn't been alcohol-free for 6 months prior to treatment. Sonic was pointing out how ridiculous that was and gave some information about his own patients but he did NOT recommend it. Bravo for your posts!
Speaking of Miles here a snippet of what he had to say back in 2K3 on high Iron.
I Am Iron Man
This is my main problem for the moment - Iron Overload. I noticed it when I walked naked past the refrigerator and all the magnets flew off and stuck to me. I gotta take my shirt off to call Pizza Hut. Iron overload is dangerous. It's called hemochromatosis.
He seems to have changed his mind a bit since then ay.
Lets move Iron Mikes thread over here its more fun that thread.
Having a debate with you would be fun
I like your posts
CS
Which bit dont you agree with me on
The I dont think you should drink with HepC or
The occasional Drink is unlikely to do much harm if not F4
Or whether Mike is Iron overloaded or not
CS.
I stated I had “a” drink, glass of wine, beer, even went out on a limb and had a margarita on shot night at times, maybe 20 out of the 53 weeks while on treatment (again my choice), why? Because I could and that I knew what the effects would be and the duration in which it would last as opposed to AD which are taken every day. It was a one shot tranquilizer that allowed me to sleep more than three to four hours when extremely needed out of the three hundred and sixty five days of TX and the riba madness and kept me moving forward. Did it alter the outcome of MY treatment? So far so good.
Good posts everyone and CS thanks! for bring up SB comments on the subject as opposed to all is evil and besides if there were any F3’s or F4’s still drinking shame on them and their doctors because at that point they should know better.
jasper
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I've already provided you with this;
http://pubs.niaaa.nih.gov/publications/arh27-3/232-239.htm
"Patients infected with the hepatitis C virus (HCV) who drink heavily are likely to suffer more severe liver injury, promoting disease progression to cirrhosis and increasing their risk for liver cancer. Some research, although not conclusive, suggests that even moderate drinking may spur liver damage in HCV–infected patients".
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here's another
http://www.ncbi.nlm.nih.gov/pubmed/12010513
Moderate alcohol intake increases fibrosis progression in untreated patients with hepatitis C virus infection.
Westin J, Lagging LM, Spak F, Aires N, Svensson E, Lindh M, Dhillon AP, Norkrans G, Wejstål R.
Department of Infectious Diseases, Göteborg University, Göteborg Sweden. johan.***@****
Although excessive alcohol consumption in combination with hepatitis C virus (HCV) infection is known to increase the risk of liver cirrhosis, the effect of moderate alcohol intake remains to be elucidated. The aim of this study was to evaluate the effect of moderate alcohol consumption on fibrosis progression in HCV infection. A group of 78 patients with HCV infection and moderate alcohol consumption were analysed retrospectively. All patients had undergone two liver biopsies, with a median time between biopsies of 6.3 years, and had not received any antiviral therapy. Their lifetime drinking history was recorded. All patients except one had daily alcohol consumption below 40 g of ethanol (median 4.8 g/day, interquartile range 1.1-11.6 g/day) during the period between the biopsies. The patients whose liver fibrosis had deteriorated had a higher total alcohol consumption and higher drinking frequency between the biopsies. The degree of fibrosis progression was greater in patients with a total alcohol intake and drinking frequency above the median level for the group. A multiple logistic regression analysis showed that drinking frequency and time between biopsies were independently associated with fibrosis progression. Hence, even moderate alcohol intake seems to increase fibrosis progression in HCV-infected patients. From that point of view, total abstention ought to be recommended. If this is not achieved, occasional use of alcohol is probably less harmful than daily drinking for patients with low or moderate alcohol consumption.
PMID: 12010513 [PubMed - indexed for MEDLINE]
By the way........ how are you going to measure.....I mean accurately measure alcohol use unless you lock people up for 20-30 years? The studies all rely on SELF REPORTING. That can be "problematic" since many people do not accurately report their alcohol use. It's practically one of the test questions for alcoholism; "do you ever lie about the amount you drink?" Were you to hazard a guess...... do you think people commonly underestimate their usage or over estimate it?
Bad reporting = flawed data
Under reporting alcohol use= less evidence of damage due to alcohol use.
I don't know exactly how we will ever prove the issue with self reporting.
Willy
Current average age of death 55 years of age.
The rate of cirrhosis in people who have had HCV 20 years; 16%
The rate of cirrhosis in people who have had HCV 30 years; 41%
I don't think that there is a study which shows the rate at 40 years....and so.... we should not assume that it is higher; right? : ) Maybe it will drop. ; )
My little joke is that yes; you can draw conclusions without complete data. I also want to convey that this virus will kill you even if you do EVERYTHING right. My feeling is that if we do more things right...maybe that is better nutrition, or taking better care of ourselves we may get a few more years than someone who doesn't. That's all that this is about. I'm OK with informed people making their own choices.
Many of the same alcohol studies are based on self reporting 20 years of alcohol use. There may not be much proof in the way of studies yet...... but given the above stats...... one might extrapolate that the results of 30 years of moderate drinking will be significantly worse. Stay tuned....... : )
Just some food for thought.
Take care,
Willy
..........i try really hard not to drink any ALCOHOL at all, but sometimes i have my weekend moments where i say "screw it"....im having a few..and they taste great...........the next day the guilts and feeling of being stupid set in along with a hangover that seems even worse now that i have liver damage.............so i swear off drinking altogether, UNTIL THE NEXT TIME...GEEZ The temptation when going out to dinner and sharing a few bottles of wine with friends is very hard for me. The wine taste great
the food seems to taste better and the laughs just keep coming and then the next day i wake up and again i feel SO SO STUPID.....
...IM Not asking anyone to preach to me or feel sorry for me....I'm just pointing out that its difficult to change an entire life style over night,,
i know it must be done or the suffering of the consequences will be
ALL ON ME...as one member put it....cirroshsis and ESLD is a WORLD OF HURT.........To me there is no argument no one with LIVER DISEASE should drink any alcohol at all.....and during TX, ,,,IF YOU WANT TO BE CURED, DONT EVEN CONSIDER LOOKING AT A BEER.......NOW i gotta start practicing what i preach ....and im working on it with all my heart......good luck all
Might help explain why we can read the same study and come to diferrent conclusions.
Alcohol: How much is too much? (part 1)
The negative effects of heavy drinking on the liver health and survival of people with hepatitis C are well-documented. Heavy drinking increases damage to the liver, leading to greater risk of cirrhosis and liver cancer (hepatocellular carcinoma).
But research on the effects of light or moderate drinking on hepatitis C disease progression have been less conclusive (download full article as a PDF file here). In the absence of clear answers, many doctors, educators, and people with hepatitis C advise total abstinence from alcohol if you have hepatitis C.
Yet veterans of the War on Drugs are instinctively wary of absolute, "Just Say No" messages. Harm reduction theory and practice originated in part from a recognition that total abstinence from substances was not always possible, necessary, or even perhaps desirable for many people. Is harm reduction an appropriate model for thinking about alcohol and hepatitis C? That depends on how you interpret the research.
A new study published in the March issue of Hepatology examines how different amounts of alcohol affect the progression of hepatitis C liver disease. The study compared the biopsy results of 800 people with hepatitis C to their reported histories of alcohol consumption, measured as average grams/day (with one drink containing 10 grams of alcohol). People were divided into four categories:
Non-drinkers -- no alcohol
Light drinkers -- up to 2 drinks per day
Moderate drinkers -- between 2 and 5 drinks per day
Heavy drinkers -- greater than 5 drinks per day
As expected, heavy drinkers had more fibrosis overall. There was a general trend showing greater fibrosis with increased amounts of alcohol, but these results were only considered statistically significant for heavy drinkers -- specifically, men who consumed on average over eight drinks a day. There was a substantial range of fibrosis within each category of alcohol consumption, and nearly half of heavy drinkers had little or no fibrosis. When all factors were considered, the most significant predictors of fibrosis were age (strongly associated with duration of hepatitis C infection, which averaged over 20 years), liver inflammation (as measured on biopsy), and ALT levels.
So what does this mean for people with hepatitis C? The headlines of two articles discussing the study reflect different interpretations:
from WebMD: "Bad Mix: Alcohol and Hepatitis C -- No Safe Alcohol Levels if You're Infected"
from HIVandHepatitis.com: "Light and Moderate Alcohol Intake May Have Minimal or No Effect on Fibrosis Development in HCV Infection"
Both perspectives are valid, and supported by the research. But they only tell part of the story. It seems that the effects of alcohol on hepatitis C progression can vary considerably, and in some cases other factors may be more important in determining fibrosis.
Coming next: translating research on alcohol into harm reduction
Alcohol: How much is too much? (part 2)
Yesterday's post discussed a new study assessing the impact of different levels of drinking on hepatitis C disease progression. The results indicated that heavy drinking, particularly in men, was associated with greater fibrosis. Beyond that, there was a trend towards increased fibrosis associated with greater amounts of alcohol consumption, but that for light or moderate drinkers the association with fibrosis progression was not statistically significant.
Here are some ways to think about this research from a harm reduction perspective:
1. Research can't always give you clear, unambiguous answers: One of the lessons of this study is that alcohol's effects may be subtle and highly variable. The study could not demonstrate a safe level of drinking, nor could it unequivocably show that even light drinking is harmful for people with hepatitis C. While more research would be helpful, it's unlikely to result in a clear formula for how much it's safe to drink, and for whom. As with many other aspects of hepatitis C, we listen to the research and learn to live with the ambiguities. Clear answers can be comforting, but they're often in short supply, and it's dishonest to impose false certainties and absolutes on the messy realities of hepatitis C.
2. Everyone's body is different: Just as people respond differently to alcohol in their mood and behavior, people with hepatitis C will likely have a range of possibilities in how drinking affects their liver. As the study authors note, some people may be more susceptible to the effects of alcohol on the liver. Even heavy drinkers in this study did not invariably progress to cirrhosis.
3. There's no way of knowing how susceptible someone is to liver damage from alcohol consumption: If you have hepatitis C, you can't predict what level of drinking is "safe" or "dangerous" for your liver. Some people with advanced liver disease can feel the effects of alcohol -- their body's telling them through symptoms that alcohol is hard on the liver. But most people won't know what effect alcohol is having on their liver from symptoms.
4. Other information about liver health can help put the risk of drinking in context: In the study described yesterday, elevated ALT levels were strongly associated with risk of greater fibrosis, as was age and liver inflammation. In other studies, obesity or a high body mass index has been associated with greater fibrosis, while female sex may somewhat protect from fibrosis progression. There's no formula for predicting your risk of fibrosis, but a biopsy can tell you where things stand with your liver. People who have been infected with hepatitis C for 20 years and have little or no fibrosis may not have to change the way they drink; people who have cirrhosis may need to take the risks of alcohol more seriously.
5. Drinking may be a risk, but it's not just a risk: People have a range of reasons for drinking -- pleasure, companionship, relief from stress, etc. Even people who aren't dependent on alcohol may be reluctant to give it up. Some drug users have worked hard to quit other drugs, like heroin, cocaine, and crack, trading them for alcohol -- drinking helps them stay away from the drugs that were creating more immediate and severe problems in their lives. If you only think and talk about alcohol as a risk for liver disease, you're missing a big part of the picture -- the reasons why people drink, and the real and perceived benefits they get from continuing to drink.
In a future post, I'll talk about how educators and people with hepatitis C are grappling with these issues. In the meantime, feel free to add a comment (click at the bottom of this post) about your take on alcohol and hepatitis C.
CS
Under reporting alcohol use= less evidence of damage due to alcohol use.
Yes i know the studies are flawed.
Under reporting alcohol use= less evidence of damage due to alcohol use.
Actually its the reverse. Under reporting means more damage seen at lower levels of consumption. You drink 8 but report three you get the idea.
CS
off to work.
w
My family member and I were talking about it. It's hard to stop doing something that you've done all your life. I was asked by a patient once, it floored me, 'would I ever consider having a transplant.' I still can't answer. I have another family member that died with a transplanted lung. I watch what people go through. And mind you, I only see the ones that don't do well, because they come to the hospital I work at. I really can't say if I would or not. I would have to answer if that time ever came.
I really enjoy your posts. I am learning so much. Please know that what you're saying is reaching people outside this particular community. It really is helping other people with Hep C. Whether you believe, agree, or disagree with each other...everything you are saying, I'm reading...and it helps me to relate to my patients in ways I never thought I would.
Have a great weekend.
I'm not a supporter of someone drinking with a transplanted liver or during treatment, but I also can't judge anyone because I am not there myself. I love my family member with Hep C with all my heart. I support everything he/she does. I cannot judge anyone because I myself am not in their shoes.
Everyone: every comment and post, though each just a drop in the bucket, has the potential to ripple so far and wide. I always appreciate people's passion on this forum, and honesty -- I think even imposters can bring out the best or worst in each of us -- I usually see the best coming out of the members here, though.
And, even if threads *seem* to go in circles... if one can stay on long enough without losing it ;-)... the rollercoaster ride is still a thrill and a head rush -- and gives much to reflect on after we get off.
Cheers to everyone :).
eureka
Hepatitis C and Alcohol
Eugene R. Schiff, M.D., and Nuri Ozden, M.D.
(this is just a brief part of the paper but describes various ways that alcohol could affect folks with HCV- While this is directed towards heavier drinker Schiff suggests that it may also apply in part to moderate drinkers. In any case it's an interesting read.......Willy)
Mechanisms of Liver Injury in Alcoholic Hepatitis C Infection
Although researchers do not fully understand how alcohol consumption accelerates liver injury in patients with HCV infection, it is likely that several factors are involved. The following mechanisms have been proposed:
Increased replication of HCV in the liver. As illustrated in figure 4, some research (although not all) has found that greater alcohol consumption is related to higher HCV RNA blood concentrations (Pessione et al. 1998). Moreover, as shown in figure 5, when people infected with HCV who drank more than 10 g of alcohol (about 5.8 drinks) per day abstained from alcohol or substantially reduced their consumption for 4 months before treatment, HCV RNA levels dropped; the decline in serum HCV RNA among subjects who drank less than or equal to 10 g of alcohol (less than one drink) per day before abstaining was not statistically significant (Cromie et al. 1996).
Mutations of the HCV virus (forming what are known as quasi–species). Alcoholics infected with HCV show greater quasi–species complexity than do nonalcoholics with HCV infection. In alcoholic HCV patients, such increased viral complexity might make it difficult for the immune system to control the mutated viruses, leading to progressive injury (Takahashi et al. 2001).
Increased programmed cell death (apoptosis) of liver cells. Apoptotic death of liver cells, which can ultimately lead to liver fibrosis, is increased by alcohol consumption in people with HCV infection (Szabo 2003).
Higher levels of inflammation and immunoregulatory proteins (specifically, interleukin, tumor necrosis factor, and interferon). In research with mice, Geissler and colleagues (1997) noted that chronic alcohol feeding in mice inhibited immune responses (specifically, responses by T–helper cells and cytotoxic T–lymphocytes) that play a pivotal role in removal of HCV from the body (i.e., HCV clearance).
Viral gene mutations.
Fatty liver. Accumulation of fat in the liver is common in patients with HCV. Examining a large group of patients with HCV infection, Serfaty and colleagues (2002) found that fibrosis progressed about twice as quickly among drinkers with steatosis as among drinkers without steatosis or nondrinkers with or without steatosis.
Accumulation of excess iron in body tissues (i.e., iron overload). Alcohol consumption increases iron stores in the liver, and iron overload seems to contribute to HCV disease progression by inducing fibrosis (Piperno et al. 1998).
Oxidative stress. Alcohol stimulates the production of reactive oxygen–containing molecules (i.e., oxygen radicals). Heavy alcohol use also depletes the body’s supply of molecules that normally defend tissues against damage caused by oxygen radicals (i.e., antioxidants). This state, known as oxidative stress, may accelerate liver damage in patients with HCV (Rigamonti et al. 2003). (For more information about how alcohol use can lead to oxidative stress and subsequent liver injury, see the article by Nanji and French in the next issue of Alcohol Research & Health, [Vol. 27, No. 4].)
Depression of the immune system by alcohol.
I almost posted a link to this yesterday.
Increased replication of HCV in the liver.
HCV RNA among subjects who drank less than or equal to 10 g of alcohol (less than one drink) per day before abstaining was not statistically significant (Cromie et al. 1996).
Figure 3 Alcohol consumption and liver fibrosis in patients with chronic HCV.
More advanced fibrosis (stages 2 through 4) was observed in
29 percent of patients who reported no alcohol intake,
34.4 percent of those who had minimal intake,
38.2 percent of those who had mild intake, and
67.6 percent of those who were moderate drinkers. Correspondingly, the incidence of less advanced fibrosis (stages 0 through 1) decreased with increasing alcohol consumption.
Minimal =1-20g alcohol per day.
Mild = 21-30g alcohol per day.
Moderate =31-50g alcohol per day.
Now how does 1-20g alcohol is this study cause anything that is statistically significant.
Heavy alcohol use can be detrimental to HCV–infected patients’ long–term response to interferon therapy (see the sidebar for discussion of interferon treatment for HCV).
It is likely that alcohol affects HCV treatment effectiveness both because drinking tends to interfere with patients’ adherence to therapy and
because alcohol interferes with interferon therapy’s antiviral actions
Heavy Drinking not minimal is where the problem you are talking about occur.
The range in the middle has no clear answer.
See how we can both read the same study and spot different things
CS
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My last post was supposed to be titled; (with a Don Pardo voice....) "Tell them what they've WON, Johnny...." Premature send off; only posted "Tell them" ; (
I posted the above Schiff/ NIH link for informational purposes, not as a source of proof in the discussion/argument.
It's fascinating.
Yes, I wish there was more data. And in the absence of data...... your assertion is that we should assume that moderate drinking is not harmful? What is your proof that it is safe? The same lack of data does not support the moderate use of alcohol (that I'm aware of). Measuring the liver damage that takes place over decades and that could be caused by many co-factors is difficult or nearly impossible to prove. Having "proof" before the event happens makes it even a more difficult order. No doubt after we are all dead the stats will be readily available, but perhaps a decade or two late to aid us in our decision. It feels as though your assertion is that in the absence of such proof we can go ahead and drink in moderation. That's a giant leap of faith.
It reminds me of many of the arguments made by the smoking lobby;
"Nooooo...... smoking doesn't cause cancer; prove it"
And medicine was unable to prove it.... not with science and not in the courts until very recently. And the cost of that delay.....could be measured in lifes lost, diminished quality of life, ruined finances (lol; I mean the sick people, not the cigarette companies) and devastated families. As they say...... and the band played on. Is this so different? You've got a drug.... an addictive drug for some..... that is proven harmful (but not in lesser amounts you assert). You want to suggest that in the absence of evidence of it's harmfullness in smaller amounts, that HCV infected people can use it....perhaps without fear or consequence.
In this thread I've provided a few studies, medical opinions of respected hepatologists, medical review boards, HCV boards. By in large the consensus is that abstinence; not taking ANY alcohol is recommended. This recommendation is always made without qualification and irrespective of any damage staging. Now, how is it that your opinion has more weight than all the experts? ; )
What if you had to prove THEY are wrong? I think that would be tough to prove.
Although the link and information which I posted pertains to all the drawbacks of heavy alcohol abuse, I see that there are many commonalities....issues that many people post about on forums on a regular basis, just regular HCV infected members;
How to improve their immune response
How to control their iron/ iron overload
How to slow liver damage progression
How to improve efficacy of treatments
Reducing extra-hepatic co-morbidities
Reducing oxidative stress (not only on the liver but the entire body)
and issues I never dreamt about (more quasi-species of HCV due to alcohol!!!)
Lots of interesting stuff..... that alcohol in large quantities is PROVEN linked to negative issues. No argument there from you I suppose.
Yes, it's interesting to see that we can read the same things and get a different read. Seriously; what do you think that we should recommend to people about their alcohol intake? My serious response is that they shouldn't drink. I think they should listen to their doctors. If they decide to choose to drink after the medical consultation it's OK with me. I think if they do it though, they should have an understanding of what they are doing. That is one reason that I've spent a little extra time on this thread. It's a reasonable source of information for the reasons of the prevailing medical view and the countervailing view. While I don't agree with you a still have a respect for your writing, research, and tenaciousness. (but the calling people Nazi's should go)
I think that if such a time comes that ....for the sake of argument..... you are dead on about the safety of drinking, I think that the allowable amount and qualifications (how often, what amount, given ones staging etc) should come from professionals; not HCV bloggers. (no offense intended. : ))
best,
Willy
calling people Nazi's should go
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Sorry about that its not my line I pinched it from Mre. Didn’t go down to well when he used either.
I posted the above Schiff/ NIH link for informational purposes
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Thats why I almost posted the link yesterday.
It reminds me of many of the arguments made by the smoking lobby;
"Nooooo...... smoking doesn't cause cancer; prove it"
And medicine was unable to prove it.... not with science and not in the courts until very recently. And the cost of that delay.....could be measured in lifes lost, diminished quality of life, ruined finances (lol; I mean the sick people, not the cigarette companies) and devastated families. As they say...... and the band played on. Is this so different? You've got a drug.... an addictive drug for some..... that is proven harmful (but not in lesser amounts you assert).
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Soon as I read that I pictured the CEOs of the Tobacco Co.s in the US Congress and in turn each standing up and saying “I don’t believe nicotine is addictive” all the while knowing that their companies were conducting research in how to make nicotine more addictive so that technology could be used in cigarettes.
Comparing what Sonic Bandaid, Hep Australia and myself have said with the lies and disinformation spread by the Tobacco Companies is disingenuous and shows a complete lack of understanding of what is known about alcohol and HepC. You are playing join the dots and missed. Liars we are not.
Is this so different? Yes. I am not trying to con or mislead anyone. The Tobacco Co’s were.
Its not my fault you don’t like what the evidence says.
Yes, I wish there was more data. And in the absence of data...... your assertion is that we should assume that moderate drinking is not harmful?
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No its not. My assertion is that low drinking levels lack evidense that it is harmful.
I do realise that lack of evidence does not make something a fact.
It simply means no evidence.
What is your proof that it is safe?
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I am not saying its safe. I am saying you cant say its harmful. And I am not playing with words here.
Lack of evidence again is my reasoning.
In this thread I've provided a few studies, medical opinions of respected hepatologists, medical review boards, HCV boards. By in large the consensus is that abstinence; not taking ANY alcohol is recommended.
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Depends which expert you want to pick don’t it. SonicBandaid is an expert, he has treated more patients in more countries than either of us.
There is no disagreement about high levels of alcohol consumption, by vitually everyone. I could run a line of argument there to if you like, but that would be irresponsible of me.
Yes, it's interesting to see that we can read the same things and get a different read.
Seriously; what do you think that we should recommend to people about their alcohol intake?
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How about stop drinking. Failing that cut down to 7 or less a week.
Both of which are damn site less risky than a 6 pack or more a day.
But then isn’t that what Hep Australia and SonicBandaid said.
So it comes down to low levels of alcohol consumption and there is no expert in the world that can say for certain that it is harmful.
No alcohol is a cautious approach based on what high levels cause.
But I don’t have any problems or issues with it as a recommendation.
Zero Alcohol is a safe limit.
My issue is with the way the message is delivered, not the message itself.
CS
Take care
Willy
So we can both give each other a break
I gained quite a bit out of this thread as well.
Few things i am going to chase up when I get back.
Jeez i hope it has faded away by then, not to be replaced by another damn alcohol thread.
Enjoy your time away from this place.
CS
Combined with other people's experiences here and elsewhere ... for TX to be effective, I suggest you need to not drink alcohol at all during TX and immediately after.
-- Allan
http://hepatitis-c-log.livejournal.com/
This thread had intrigued me so much that I had copied and pasted to a word doc and edited out all except the discussion put forth by both and came up with about 65 pages of excellent information on the subject of Alcohol.
As always it comes down to personal choice.
Who knows how to put this thread on the Health Page?
jasper
I've got to pack....and here I sit at the damn computer again. : )
Thanks to all who wrote. I agree; good food for thought. For what it's worth CS and I have already written each other a PM with a thanks.
Take care of yourselves....... I'm off on an adventure. : )
Willy
jasper