HR discussion at:
Supplements as of 1/1/08
I have added links if additional info wanted.
B12 (1000 mcg) , B6 and Folic acid (800 mcg)
a multi vitamin/no iron
1000 mg of Salmon Oil (epa=160 mg / dha=240 mg / omega 3 = 400 mg) x1
1000 mg of ALA
Raw flaxseed/ 1 teaspoon daily
Hepatapro PPC (900 mg) x 2
Resveratrol (500 mg) x1 and x2 (alternate every other day)
SAM-E (200mg) x 2
NAC--(n-acetyl-l-cysteine) A sulfur compound that is a precursor of glutathione and protected sulfur-containing amino acid (600 mg) x2 with Vit C (500 mg) x2
TMG (750 mg) x 2
Taurine (500 mg) x 2
In a double-blind, randomized study (3), acute hepatitis patients were given taurine in the amount of 4 grams 3 times a day after meals. The participants in the taurine study experienced significant decreases in bilirubin, and total bile acids.
Super Biocurcumin 800Mg 60 Caps (800 mg) x 2 / Powerful Antioxidant Properties to scavenge free radicals
Enhances important detoxification enzymes Curcumin increases the secretion of bile by stimulating the bile duct. It also protects the liver by detoxification, stimulating the gall bladder and scavenging free radicals. With the help of the adrenal glands, it inhibits both platelet aggregation and the enzymes which induce inflammatory prostaglandins. Curcumin may also help break down fats and reduce cholesterol. Large doses not recommended in cases of acute bilious colic, obstructive jaundice, painful gallstones, and extremely toxic liver disorders
Sylmarin (425 mg) x 2 / Milk thistle provides hepatocellular protection by stabilizing hepatic cell membranes.
Green Tea Extract (300 mg) x 2 /
Coq10 (200 mg) x 1 / http://tinyurl.com/29em8c
Inulin 1 teaspoon daily
Lactobacillus GG (culterelle) 1 tab x 2
What to take while on tox per HR
The supplements while on tx question is difficult, because the ones having antifibrotic promise are almost all antiinflammatory, somewhat reducing the initiating events at the dendritic cell/lymphocyte interface.I know this sounds technical. Most of them also have, paradoxically an improving effect on some aspects of lymphocyte function, as the spectracell test clearly shows.
Bottom line, NO CLEAR ANSWER possible regarding use during tx.
But a moderate use of NAC/VitC, TMG, ALA ( those are quite cheap and possibly PPC (since it was actually shown to help the SVR rate) is probably a good idea even during tx. Vit D3 is good, but it would be best to know ones serum level.
Also some Inulin is inexpensive (http://www.raysahelian.com/inulin.html) and a very good well researched prebiotic. Cannot get Lactulose here in the US without script. Available w/o script in Canada. Inulin is the alternative.
-------------------------------------------------------------------------------------There is no fundamental difference between pre tx and post tx antifibrotic measures, except that once you are SVR you can hope/expect the profibrotic inflammatory process in the liver to slow down or in the balance with the constant removal of some fibrosis to tilt towards reduction by itself.
The diet principles of small volume, high fiber meals to reduce the metabolic stress on the liver, removal of adipositas and the principle of prebiosis/probiosis/eubiosis apply always before any "supplements" should be taken.
The glutathione replenishing Sulfur containing NAC, ALA, Taurine and SAMe, possibly if affordable combined with actual glutathione ( some will be absorbed and the rest will supply building blocks) are good starters for liver protection. TMG also tends to improve liver metabolic performance, since it supplies the Methylgroups needed in numerous biochemical reactions. What you already take is fine too, many of these "supplements ' work in concert and while there are many studies on cells and animals, there are few human trials, since nobody will want to pay for these.
Addendum: by gauf
B12, B6 and Folic acid
"Protecting against ribavirin-induced anemia. Hemolytic anemia can result from the use of ribavirin in about 10 percent of cases. Folic acid and vitamin B12 (as methylcobalamin) may protect against ribavirin-induced anemia. The methylation-enhancing effects of both folic acid and vitamin B12 will also improve the liver-protecting effectiveness of S-adenosyl-L-methionine (SAMe) (Bottiglieri T et al 1994; Swain RA et al 1997). Serum ferritin levels are closely monitored during interferon and ribavirin therapy to ensure that iron levels stay within the normal range. Iron supplements are to be taken only under direction of a healthcare provider."
Boosting Liver Glutathione Levels
Glutathione is the most important antioxidant used and manufactured by the liver. It kills bacterial invaders, acts as a cellular detoxifier, and helps prevent damage from free radicals. In patients with hepatitis C, particularly those who are HIV positive, a systemic depletion of glutathione is observed, especially in the liver. This depletion may be a factor underlying the resistance to interferon therapy and a biological basis for supplementing with the following nutrients that raise glutathione levels (Moriya K et al 2001):
N-acetyl-cysteine. N-acetyl-cysteine (NAC) is derived from L-cysteine, a conditionally essential amino acid. NAC is more efficiently absorbed and also acts as an antioxidant.
S-adenosyl-L-methionine. S-adenosyl-L-methionine (SAMe) is an effective antidepressant that also helps regenerate normal liver function by increasing glutathione levels and decreasing the activity of free radicals. It is one of the most important liver-protecting substances in the body.
Lipoic acid. This acid is used by almost every tissue in the body as a free-radical fighter. It also helps regenerate other essential antioxidants and acts as a metal chelator.
Whey protein isolate. This protein boosts glutathione levels and improves the functioning of the immune system. The fact that hepatitis C often becomes active in people after they reach the age of 40 indicates that age-associated immune decline plays an important role in the progression of the disease.
Life Extension Foundation Recommendations
Some herbs are metabolized in the liver and can be toxic to it, especially in high doses. The following herbal products have demonstrated liver toxicity: germander, comfrey, chaparral leaf, ma huang, pennyroyal, skullcap, and mistletoe. If one desires to use any of these herbal products, it is advisable to do so under the care of a physician and with careful monitoring of liver enzymes and hepatitis C viral counts (Harvey J et al 1981; Gossrau R et al 1990).
Hepatitis C latches on to iron to inflict free-radical damage on liver cells. One way of reducing these toxic free radicals is to lower the amount of iron in the liver. Serum iron levels should be maintained at the lowest possible tolerable levels (ideally below 60 mcg/dL of blood), and serum ferritin levels should be maintained in the low normal range of 30 to 80 ng/dL.
Another way of protecting the liver is to consume the proper antioxidant nutrients to protect cells against the damaging effects of free radicals. A healthy immune system may keep hepatitis C in check. Supplements that help maintain youthful immune function are of particular importance.
The following supplements have been shown to reduce liver oxidative damage, lower iron, and boost the effectiveness of conventional drugs:
Calcium citrate—1000 to 2000 milligrams (mg) daily with iron-containing foods to block iron absorption
Lactoferrin—900 mg daily, to block iron, in divided doses
Lipoic acid—750 mg in three divided doses daily
NAC—600 mg daily
Whey protein isolate—20 to 40 grams (g) daily
Glutathione—500 mg daily, on an empty stomach
Silibinin extract—900 mg daily, in two divided doses
SAMe—1200 mg daily, in three divided doses
PPC—1800 to 3600 mg daily
Green tea extract (93 percent polyphenols)—750 mg daily
Garlic (high allicin)—900 mg daily
Aged garlic extract (Kyolic®)—1200 mg daily
Selenium—200 to 600 micrograms (mcg) daily
zinc -200mg daily ?
magnesium 500 x 1
Vitamin E—400 international units (IU) daily with at least 200 mg gamma tocopherol
Vitamin C—2000 mg daily (on an empty stomach to minimize the increased iron absorption caused by vitamin C)
Here is what I take. Cordycep, Astragulas, Olive leaf, PPC, Taurine, Sam e, TMG, NAC/Vitc, Glutathione, Oxymatrine, B6 and B12, folic acid, selenium, zinc, magnesium, ALA, salmon oil, Inulin/Culterelle, Qc10, Garlic, calcium, Whey protein powder, Vit D, creatine, shark liver oil, potassium for muscle cramps with tonic water, along with 1600 riba, the alinia, and double dose peg, lactoferrin at eot taper, and prayer! Phew! If that don't kill the little buggers than nothing will!
To: Sir HR
quote: "PPC,NAC,ALA,TNG,SAme,silymarin,catecchin,resveratrol,curcumin, are probably a very good component of a minimum lover health regimen."
would you please elaborate on the recommended therapeutic doses of each of the above.
am starting to get it (although i wish i could pull up your discussions from a year ago regarding your lengthy explanation of the eubiosis/probiotic/prebiotic concept. the prevention of pro inflammatory LPS input to the liver from the intestines. will contiue to try
now i know i am the cow in the field for interupting this great discussion! all are welcomed to ring the bell on the cow. sigh
may i suggest......please consider writing a short reference book of nutrition and liver health and market it soon as possible! i would love to have it as a reference since you won't adopt me.
Reported Report this Spam
Nov 17, 2007 01:44PM
ahhhh i meant liver.....not lover...LOL but then again i am a liver lover ;)
by Hepatitis Researcher
Nov 17, 2007 06:41PM
Lost another lengthy post - landing in a spinal therapy center??
Your liver to lover slip of fingers was not so far off : These substances will definitely improve endothelial function - the production of NO............
Addendum 7/08 courtesy of Marcia...
There are two sources of liver damage with chronic hepatitis C. One is from the infection itself. The other is from the immune system’s attempt to fight the virus. Even if you eat a healthy, balanced diet that provides a broad spectrum of nutrients, there is still an important role for nutritional supplements. Antioxidants, amino acids, and fatty acids help moderate liver damage and improve the health of people with hepatitis C.
A process called oxidative stress plays a role in the progression of chronic hepatitis C. Oxidative stress occurs when free radicals (unstable electrons and oxygen molecules) move through the liver causing inflammation and scarring. Free radicals form naturally in the body, especially when the immune system attacks an invader. The process is accelerated in chronic viral infections. The amount of damage caused by oxidative stress is linked to both the grade of liver fibrosis and the overall level of liver damage.1, 2
The level of glutathione (an antioxidant) is significantly depressed in many people with hepatitis C.1 Insufficient amounts of glutathione can reduce the liver's ability to break down drugs, chemicals, and other toxins. This can result in liver damage.
A study of people chronically infected with the hepatitis C virus (HCV) found their blood levels of the antioxidants glutathione, vitamin A, vitamin C, vitamin E, and selenium were much lower than those of people the same age and sex who did not have HCV.3 Low levels of antioxidants were accompanied by high levels of blood markers that indicate oxidative stress (damage from free radicals). The levels of these markers were closely correlated to the amount of liver fibrosis. The higher the level of oxidative stress, the more advanced the fibrosis. Fibrosis was also related to low blood levels of the same antioxidants.
These findings applied not only to people with significant fibrosis and cirrhosis on liver biopsy, but also to those with minimal fibrosis and no cirrhosis (Ishak scores of 0-2). Higher levels of oxidative stress were associated with lower levels of antioxidants and more severe liver damage. The most important information this research reveals is that even in the beginning stages of hepatitis C, antioxidants are important. Although this information does not prove antioxidants prevent liver damage, the authors of this research suggested that antioxidants might play an important role in slowing the progression of HCV and delaying the onset of cirrhosis.
Nutritional antioxidants can counteract the damage caused by oxidative stress and low glutathione levels. Many different antioxidants work in many different ways in the body. These include vitamins A, E, and C, the family of carotenoids (including beta-carotene), the minerals zinc and selenium, alpha-lipoic acid, N-acetyl cysteine, and SAMe.
The antioxidants vitamin E, N-acetyl cysteine, SAMe, and selenium have been studied in people with hepatitis C to determine their effect on liver inflammation. The process of inflammation involves the accumulation of fat in the liver. Fatty cells are susceptible to damage, which can cause fibrosis and, ultimately, cirrhosis.4, 5
Vitamin E, selenium, zinc, and N-acetyl cysteine (NAC) have also been studied for their potential to inhibit fibrosis in chronic hepatitis. Of particular importance are the antioxidants and nutrients that work together to increase glutathione. The use of supplements to normalize glutathione levels may be very important for preventing liver damage. The nutrients that contribute to glutathione production are alpha-lipoic acid, vitamin C, vitamin E, NAC, and glutamine. The B vitamins and the mineral selenium also contribute to the antioxidant defense system.
Following are descriptions of several nutritional supplements, their effects in the body, and their roles in maintaining or improving liver health.
Alpha-Lipoic Acid (ALA)
Alpha-lipoic acid is a fatty acid and antioxidant. It is very important in liver cell metabolism. ALA is rapidly depleted when the liver is under stress. ALA has a long history of use in Europe where it is used to treat liver disorders because of its apparent ability to help the liver repair itself.6 ALA’s effectiveness in raising cellular glutathione levels is thought to be very important for liver repair with diseases like hepatitis C and HIV since both cause glutathione deficiency.
Unlike most other antioxidant nutrients that work in either the fatty parts of the body (including the outer layers of cells) or the watery parts (including the blood), ALA works in both. This allows ALA to provide protection to cells throughout the body. ALA also helps recycle and regenerate other antioxidants including vitamins E and C. This helps maintain optimal levels of these nutrients in the body. ALA has been given in doses up to 1200 mg intravenously without toxicity. The only side effect reported was nausea and vomiting, and this was reported infrequently. No side effects have been reported with oral doses up to 1000 mg daily.7, 8 Oral ALA doses of 500-1,000 mg have been well tolerated in placebo-controlled studies.9
Glutamine is an amino acid normally found in greater abundance in the body than any other free amino acid. It is crucial to many body functions including maintenance of optimal antioxidant status, intestinal health, and immune function. Glutamine powers immune cells and is therefore in high demand in the bodies of people living with viral infections.
Researchers believe that among people with chronic hepatitis C, the body’s demand for glutamine can exceed the amount that can be supplied in the diet.10 Lack of glutamine can result in inadequate production of glutathione, which is needed to counteract the oxidative stress of chronic hepatitis C. The reason is somewhat complex, but simply stated, glutamine is the factor that determines how much glutathione the body can produce if a sufficient amount of cysteine is available (see the discussion of NAC and cysteine production for additional information). If glutamine stores are depleted by ongoing immune system demands, glutathione production will be inadequate. This situation is particularly important for people coinfected with HCV and HIV because their immune systems are fighting two chronic infections instead of one.
Glutamine is an important nutritional supplement. It is given to support the liver and its glutathione production. Research suggests doses of at least 10 grams of powdered glutamine daily for people coinfected with HCV and HIV (J. Shabert, personal communication).
N-Acetyl Cysteine (NAC)
NAC is a form of the amino acid cysteine found in plants and animals. Like all amino acids, cysteine is a building block of proteins. NAC has been used to treat lung diseases and acetaminophen poisoning. It is used in acetaminophen poisoning to increase glutathione in the liver. NAC has been shown to increase blood glutathione in HIV-infected patients with low levels of glutathione because of their chronic infection.11 One study of 24 hepatitis C patients who had low glutathione showed that 600 mg of NAC taken three times daily along with interferon led to a normalization of ALT in 41% of patients.12 The viral loads of patients who were on NAC were significantly lowered. NAC appeared to have the important effect of bringing glutathione levels back to normal inside white blood cells after six months of the combined therapy. NAC alone had no effect.
However, the results of studies using NAC in hepatitis C are conflicting. A study of low dose NAC (1,200 mg daily) along with 600 IU per day of vitamin E and interferon found no effect on liver enzymes.13 Similar studies using 1,800 mg daily doses of NAC and interferon also found no effect on liver enzymes. Researchers found no changes in glutathione levels in the blood or white blood cells.14 A separate study that included NAC at 1,800 mg per day had no effect when it was given along with selenium and interferon.15
It is unclear whether NAC has no influence on the effectiveness of interferon or if larger doses are needed to have an effect. In one study, the doses necessary to raise glutathione levels in HIV-infected people appeared to be 3,200-8,000 mg daily.11 Unfortunately, doses that high often cause nausea. The authors of this research have speculated that doses of approximately 2,000 mg may be capable of achieving the same effect. However, the dose of 1,800 mg used in some studies with hepatitis C patients was very close to that amount and still had no effect.
Studies of HIV-infected people who improved on a combined antioxidant protocol of NAC, glutamine, vitamin C, vitamin E, selenium, and beta carotene indicate that antioxidants may need to be given together to have an effect.10 Antioxidants work in different ways in different places in the body, and interact with each other in many positive ways. It is not at all surprising that better results are seen in people given a broad spectrum of antioxidant nutrients rather than one alone. In the case of NAC, many people with hepatitis C may be deficient in glutamine. Those who are coinfected with HIV have an even higher risk of glutamine deficiency. Although the cysteine in NAC is initially the limiting factor in how much glutathione can be produced, when enough cysteine is present, glutamine becomes the limiting factor. Thus, if people are deficient in glutamine, all the NAC in the world will not raise glutathione levels and, therefore, will not provide liver protection.
Another important factor that can influence the results of NAC supplementation is its form. To maintain its antioxidant capacity, NAC must be manufactured with care and packaged in a way that prevents oxidation. Products that are not manufactured and packaged carefully can oxidize over time, losing their antioxidant capacity. It is best to choose products made from pharmaceutical grade NAC and packaged in vacuum-sealed containers known as blister packs, which protect against oxidation.
NAC should always be taken with meals. It should be avoided if you have active stomach ulcers.
Selenium is a mineral that has been investigated for its potential to improve immune function and decrease cancer risk. Selenium provides powerful antioxidant protection to the body via the selenium-containing enzyme glutathione peroxidase. This enzyme helps the body maintain sufficient levels of glutathione in the liver and all other glutathione containing cells of the body. Selenium is one of the most crucial of all nutrients for maintaining effective immune responses. Many cancer researchers believe it is one of the most important nutrients in preventing cancer. 16
Selenium is one of the antioxidant nutrients found in significantly reduced levels among people with hepatitis C.3 People with hepatitis C who did not have cirrhosis had selenium levels 20% below normal, and those with cirrhosis had levels 40% below normal. Selenium is very important both as an antioxidant and as a cancer prevention agent. Therefore, low selenium levels in people with hepatitis C could contribute to progressive liver damage and the development of liver cancer. A recent study looked at blood selenium levels in 7,342 men with chronic hepatitis B and C and their risk of developing liver cancer (hepatocellular carcinoma).17 For analysis, the participants were divided into four groups based on their selenium levels. The study found selenium levels were lowest in the men with chronic hepatitis C. Participants in the group with the highest selenium levels were 38% less likely to get liver cancer than those in the group with the lowest selenium levels. This decreased risk of liver cancer was greatest in the men with chronic hepatitis C who smoked and had low levels of vitamin A or carotenoids. Carotenoids are vitamin A-like compounds and include beta-carotene. Although this study does not prove that selenium is the direct reason people developed less liver cancer, other studies have shown that selenium does play a protective role against liver cancer in people with chronic hepatitis.
Another selenium study conducted in China, an area with high rates of chronic hepatitis B and liver cancer, involved 130,471 people. Participants were given table salt that had been supplemented with selenium and were followed for eight years.18 The rate of liver cancer in people taking supplemental selenium was found to be one-third lower than the usual liver cancer rate observed in that area. The same study included 226 people with chronic hepatitis B. Participants were given either 200 mcg of selenium daily or a placebo (an inactive substance), and were followed for four years. No one in the group that took selenium (113 people) developed liver cancer. Of the 113 who took placebo, seven developed liver cancer. The selenium was then taken away, and both groups were followed for another four years. The incidence of liver cancer in people no longer taking selenium rose to a rate similar to those who never took selenium. This indicates the supplemental selenium may have had a preventive effect on the development of liver cancer in this particular group of chronic hepatitis B patients.
A study that examined selenium levels in HIV-positive people showed people coinfected with HCV and HIV had lower levels of selenium than those who had only HIV.19 HIV infection is more likely to be fatal in a person who is selenium deficient.20 Clearly, having HCV, HIV, and low selenium is not a good combination. We know coinfected people experience an accelerated rate of disease progression. Although we currently have no proof that selenium deficiency is a cause for accelerated disease progression, having adequate selenium appears to be helpful.
Studies on selenium supplementation have used 50-400 mcg (micrograms) daily of different forms of selenium. Research is currently underway at the University of Miami with HIV positive patients taking 400 mcg of selenium per day (M. Baum, MD, and E.W. Taylor, personal communication). Selenomethionine, a well-studied form of selenium, appears to be one of the safest and most absorbable forms of selenium. Other forms of selenium can be toxic at high doses.1
Selenium provides general antioxidant protection and immune defense. Selenium in doses of 200-400 mcg daily may also provide protection against the development of potentially life-threatening liver cancer.
S-adenosyl-L-methionine (SAMe) is another compound that aids glutathione production in the liver. SAMe is an amino acid that can be made in the liver. It helps cell membranes (the outside layer of a cell) function normally. It also assists in detoxifying drugs and other compounds the liver processes.21
SAMe is used as a medication to treat liver disease in Europe. SAMe is usually called AdoMet in Europe. It has been shown to delay the need for liver transplantation in people with alcoholic cirrhosis.22 Recent research revealed that SAMe has the ability to protect normal liver cells while causing liver cancer cells to die.23 Although this research does not mean that SAMe alone can prevent or treat liver cancer, it does indicate that SAMe may provide some protection against developing liver cancer.
Other research involving liver disease and SAMe centers around its ability to normalize bile secretion by the liver, a process commonly affected by chronic liver diseases. SAMe has been used in multiple studies to treat the chronic skin irritation and resulting itching (pruritus) that is a common symptom of hepatitis C and many other chronic liver diseases. Studies in hepatitis B and C, and other chronic liver conditions found that SAMe helps reduce the symptoms of itching, jaundice, and fatigue, and lowers liver enzymes and bilirubin levels in as little as 16 days.24, 25 Doses of SAMe in these studies were either 800 mg intravenously, or 800-1,600 mg by mouth. No side effects were reported in any of the studies with SAMe in chronic liver disease. More studies with SAMe are needed in the United States since all of the current studies were done in Europe or Russia.
SAMe is sold over-the-counter. It is usually packaged in bottles or vacuum-sealed containers known as blister packs because it oxidizes (loses its potency) easily. SAMe is expensive, so some people take a combination of the amino acid methionine, tri-methyl glycine (betaine), vitamin B12, and folic acid to help the body make its own SAMe. The dosages for this combination are 500 mg methionine, 500 mg betaine, 800 mcg folic acid, and 500-3000 mcg of vitamin B12 daily. Whether this combination results in the same effect as taking supplemental SAMe is unknown. However, betaine, folic acid, and vitamin B12 are nontoxic and do not have any harmful side effects at these doses.
Vitamin C (ascorbic acid) is a powerful antioxidant and natural anti-inflammatory agent. Both characteristics are crucial for people with hepatitis C since much of the damage caused by HCV comes from a combination of oxidative stress and inflammation in the liver. Vitamin C is also very important for immune function. The white blood cells that perform many of your immune functions are dependent on vitamin C. Therefore, vitamin C is a crucial nutrient for control of any viral infection. Individual needs for vitamin C seem to vary. For this reason, recommended dosages can range from 1,000-6,000 mg or more per day. Amounts in excess of individual tolerance can result in gas and/or diarrhea.
Vitamin E is an antioxidant that works in the fatty parts of the body, including the outer layers of cells called cell membranes. It is crucial for the protection of liver cell membranes.
In one study, 24 people with hepatitis C undergoing interferon therapy were divided into three treatment groups. Group one took interferon alone. Group two took interferon plus 1,800 mg of NAC and 400 mcg of selenium per day. Group three took 544 IU of vitamin E per day in addition to interferon, NAC, and selenium.15 Liver enzyme levels, HCV viral load, and response to interferon were similar in the first two groups. Those who received the complete combination that included vitamin E had a significantly greater response to treatment and achieved significantly greater drops in viral load. Although the study was small and the relapse rate was equal in all groups, the effect of the combination that included vitamin E was significant and merits more research. It is unclear whether the vitamin E alone should be credited with the improved results or, perhaps more likely, the improvement was the result of using an effective combination of nutrients. It is always important to remember that nutrients interact in many ways and places in the body. Thus, combinations often work better than an individual nutrient.
Another study of 23 hepatitis C patients on 800 IU of vitamin E found almost half the participants experienced improvement of liver enzyme levels.26 Liver enzymes went back up almost immediately after stopping the vitamin E. This indicates that vitamin E was neither combating the viral infection nor permanently stopping the process of inflammation in the liver, but was directly affecting inflammation in the liver while it was being taken. In other words, vitamin E only works while you take it. Other studies looking at the use of vitamin E and other antioxidants along with interferon have found similar results. It appears that vitamin E taken with interferon does not reduce viral levels long-term and therefore, does not make interferon more effective.13 However, it may slow the process of fibrosis.1
Vitamin E appears to work by interrupting the biochemical pathway that leads to fibrosis in the liver. Fibrosis can lead to cirrhosis. A study of six patients on 1,200 IU of d-alpha tocopherol (a form of vitamin E) per day for eight weeks resulted in a complete interruption of this pathway, but had no effect on viral loads.27 Animal studies have shown d-alpha tocopherol inhibits the genetic mechanisms that lead to cirrhosis.28
Vitamin E and vitamin C supplementation was recently examined in a study of people with NASH but without HCV. NASH stands for non-alcoholic steatohepatitis. NASH is a disease in which increased liver fat can lead to fibrosis and cirrhosis. It occurs in people with and without HCV who do not drink large amounts of alcohol. The study participants took 1,000 IU of vitamin E and 1,000 mg of vitamin C daily along with a low-fat diet and weight loss plan. After six months, participants' liver biopsy results improved significantly.29 It is unclear whether the same results would occur in someone with NASH and chronic hepatitis C. But these vitamin dosages are safe, and we know vitamin E has a measurable effect in chronic hepatitis C. Therefore, it seems reasonable that this combination may be helpful in someone with both conditions. However, a large clinical trial is needed to determine this with certainty.
A dose of 800-1,200 IU of vitamin E daily is safe, unless you are on a blood-thinning drug such as coumadin or suffer from a vitamin K deficiency.30
Patients with chronic liver disease have low levels of several minerals including zinc.31 Zinc deficiency is known to suppress the immune system. In studies of people with chronic hepatitis C, zinc supplementation was found to increase the effect of interferon therapy.32 A recent study looked at the effect of zinc in people with HCV genotype 1b. Participants were given interferon alone or interferon plus daily doses of a zinc-containing product called polaprezinc. Polaprezinc is a combination of zinc and the amino acid L-carnosine. L-carnosine is a small molecule composed of the amino acids histidine and alanine, which is known to possess strong antioxidant properties. The amount of elemental (pure) zinc contained in the polaprezinc used for this study was 34 mg per day. Although the study was small (75 patients), the findings were impressive. Forty percent of people with viral counts less than 500,000 had a complete response to treatment. A complete response in this study meant no measurable viral load and a normal ALT for six months after the end of treatment. The study response rate was considered significant because it was markedly higher than what had been previously documented with interferon monotherapy among people with HCV genotype 1b. More studies are needed with much larger numbers of people with HCV genotype 1b to determine if polaprezinc can augment response to western therapy. It is unclear whether the positive effects seen in this study were primarily due to the zinc, the carnosine, or the combination of the two. It is also unknown whether other forms of carnosine or zinc would have the same effect. Polaprezinc is an approved drug in Japan, but is not available in the United States. However, both zinc and carnosine are available as supplements. It is not known whether taking zinc and carnosine as separate supplements has the same effects as polaprezinc itself.
Nutritional Supplement Combinations
Antioxidants and other nutrients interact with each other in positive ways. Therefore, it comes as no surprise that positive results occur in trials in which people are given a combination of nutrients rather than any single nutrient.
A combined antioxidant approach has been used in research conducted at the Integrative Medical Center of New Mexico in Las Cruces, New Mexico.33 Three patients with progressive hepatitis C and moderate to severe cirrhosis were treated with a combination of 600 mg of lipoic acid daily, 400 mcg of selenium daily, 900 mg of silymarin daily, 100 mg of vitamin B complex twice per day, 400-800 IU of vitamin E daily, 1,000-6,000 mg of vitamin C daily, 300 mg of coenzyme Q-10 daily, and one multiple vitamin and mineral supplement daily. In addition to the supplements, participants were advised to eliminate alcohol, sugar, and caffeine, to decrease their meat intake to a few times weekly, to increase intake of purified water to eight glasses daily, and to begin a modest exercise program. The nutrients in this protocol were chosen because of their ability to protect the liver from free radical damage, to increase the levels of other important antioxidants, and to interfere with the progress of HCV infection. The results were very impressive. There were reductions in ALT of at least 60% in all three patients, and more significant improvements in overall health and well-being. After 5-12 months on the protocol, all three patients achieved sufficient improvement in liver function to avoid liver transplant. The yearly cost of this nutrient therapy is very small compared to the cost of liver transplant surgery. According to the investigator, treatment with a combination of nutrients is a reasonable approach during the evaluation process prior to liver transplant so that if significant improvement can be achieved, surgery can be avoided.
There is strong evidence that nutritional supplements such as antioxidants can play a very important role in limiting the damage HCV causes in the liver. Antioxidants can counteract the damage caused by increased free radical activity in the body. Other nutrients such as glutamine are important in the production of glutathione, an antioxidant used by the liver to break down toxins, drugs, and chemicals. Adding appropriate nutritional supplements may have a significantly positive effect on the health of your liver and on the progression of hepatitis C.