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Cirrohsis and Milk Thistle
My Brother has Cirrohsis due to Hep C and is also a Diabetic. He has been hospitalized for the last month due to ammonia and fluid build up in his system which caused him to be in a unconscious-like state. It took him several days to come around from this state but he is now conscious although it seems to have affected his memory and he is very weak.
He is currently on Lactulose 5 times a day and he does have some kidney problems although I don't know how severe. The doctors are having a problem keeping his sugar down a couple of days ago his sugar was 500.
I am deeply concerned about him and I don't know what to do or what we should be doing for him. He is a candidate for a liver transplant providing that he can stay healthy enough.
I've read that Milk Thistle can help the liver - what do you know about this plant/herb?
He is currently on Lactulose 5 times a day and he does have some kidney problems although I don't know how severe. The doctors are having a problem keeping his sugar down a couple of days ago his sugar was 500.
I am deeply concerned about him and I don't know what to do or what we should be doing for him. He is a candidate for a liver transplant providing that he can stay healthy enough.
I've read that Milk Thistle can help the liver - what do you know about this plant/herb?
yes, in terms of viral load, the "consistency" thing applies for me and my own doc for that matter. If you have a high viral load, say 8 million or something, and you use these products over the long term, say 6 months, and your viral load drops to under a million or around there, and consistently stays there, I'd be optimistic, better than not dropping for sure. But of course, you still have the virus and viral load does fluctuate more than anything.
As far as this stuff is concerned, I'd pay more attention to the liver enzyme readings - Alts, etc. indicating inflammation. A lot of inflammation going on means more liver cells die off, even if youre last biopsy was a 1 it "might" indicate that you'll progress to higher biopsy scores a little more quickly...? I know a guy who was a bx 0, yet his alts were in the 300s and stayed there so he was urged to go on treatment notwithstanding the low bx score. He's over treatment now and he cleared, so he doesnt' even have to bother with this anymore, another reason to take treatment for many!
As for myself, and this is the truth although none of you can verify it of course, ha! (Except I'm seeing a member here soon and maybe she can verify my labs if she wants to.) When I went off my regimen last summer, my alt went from 44 (slightly elevated for a woman, some researchers and docs think that women should be scoring a little less on these readings then men, and normal should be calculated more in the teens, 20s and 30s, only slightly higher for men. Many docs think that mid 40 readings are normal, not true say some docs. Yet another conflict in ideas.) Anyway, it went from 44 around there, to 78 off my regimen. I went back on my regimen, last reading was 39. Could be a big coinkydinky???, I think not, because with those lower alts came my feeling better.
Of course I can't scienticfically validate this. I have other friends that live around here, and people I've spoken to on boards, that have taken down their liver enzymes to normal and almost normal and kept them down on these types of regimens. I don't doubt that some of you know people like this as well.
I agree with Jim that maybe a few of these products, particulary the herbs, might be a little dicey on tx, because they need readings on what your levels are without any anti-inflammatories cept the meds. And I hear that you are soooo burnt out on taking oral medication that taking supplements is especially trying, I can understand that. I personally still would try to supplement with many of these substances while on tx because you are only addressing nutritional deficiencies caused by taking meds, an impaired liver, etc.
That's my point, this disease impairs the liver to varying degrees and these products act mostly are like super foods to address the deficiencies you can get with an impaired liver. They are not voodoo. Many people that are healthy, without the disease, take them because they are not always able to eat properly and/or they consider deficiencies in the food making process, soil, etc.
Believe me, if I were perfectly healthy, I wouldnt take most of what I take now, I'd take a good multi w/out iron and maybe one or two other things, whey protein and glucosamine&chondrointin&MSM and leave it at that. And of course I'd veggie juice, ha! Admittedly, some of this is because I'm vain, I like looking younger than my age, there I said it.
Glutathione, other amino acids, glyconutrients, NAC, ALA, minerals, a lot of these enzymes and vitamins you already get anyway from foods. Me and Tallblonde, and some others, are just giving our bodies extra doses of these substances to bombard the blood with anti-oxidants, etc. to address free radical damage - and in so doing - perhaps address inflammation issues.
And her point - that if you are waiting around anyway, for better treatments down the line, because you have no other choice, or a doctor recommends that strategy, why not try these products? The big "3" or as many as you can afford; to help w/ inflammation issues, etc. I don't see what the big whup is...they are pretty benign. Dont work, don't take them anymore.
As far as this stuff is concerned, I'd pay more attention to the liver enzyme readings - Alts, etc. indicating inflammation. A lot of inflammation going on means more liver cells die off, even if youre last biopsy was a 1 it "might" indicate that you'll progress to higher biopsy scores a little more quickly...? I know a guy who was a bx 0, yet his alts were in the 300s and stayed there so he was urged to go on treatment notwithstanding the low bx score. He's over treatment now and he cleared, so he doesnt' even have to bother with this anymore, another reason to take treatment for many!
As for myself, and this is the truth although none of you can verify it of course, ha! (Except I'm seeing a member here soon and maybe she can verify my labs if she wants to.) When I went off my regimen last summer, my alt went from 44 (slightly elevated for a woman, some researchers and docs think that women should be scoring a little less on these readings then men, and normal should be calculated more in the teens, 20s and 30s, only slightly higher for men. Many docs think that mid 40 readings are normal, not true say some docs. Yet another conflict in ideas.) Anyway, it went from 44 around there, to 78 off my regimen. I went back on my regimen, last reading was 39. Could be a big coinkydinky???, I think not, because with those lower alts came my feeling better.
Of course I can't scienticfically validate this. I have other friends that live around here, and people I've spoken to on boards, that have taken down their liver enzymes to normal and almost normal and kept them down on these types of regimens. I don't doubt that some of you know people like this as well.
I agree with Jim that maybe a few of these products, particulary the herbs, might be a little dicey on tx, because they need readings on what your levels are without any anti-inflammatories cept the meds. And I hear that you are soooo burnt out on taking oral medication that taking supplements is especially trying, I can understand that. I personally still would try to supplement with many of these substances while on tx because you are only addressing nutritional deficiencies caused by taking meds, an impaired liver, etc.
That's my point, this disease impairs the liver to varying degrees and these products act mostly are like super foods to address the deficiencies you can get with an impaired liver. They are not voodoo. Many people that are healthy, without the disease, take them because they are not always able to eat properly and/or they consider deficiencies in the food making process, soil, etc.
Believe me, if I were perfectly healthy, I wouldnt take most of what I take now, I'd take a good multi w/out iron and maybe one or two other things, whey protein and glucosamine&chondrointin&MSM and leave it at that. And of course I'd veggie juice, ha! Admittedly, some of this is because I'm vain, I like looking younger than my age, there I said it.
Glutathione, other amino acids, glyconutrients, NAC, ALA, minerals, a lot of these enzymes and vitamins you already get anyway from foods. Me and Tallblonde, and some others, are just giving our bodies extra doses of these substances to bombard the blood with anti-oxidants, etc. to address free radical damage - and in so doing - perhaps address inflammation issues.
And her point - that if you are waiting around anyway, for better treatments down the line, because you have no other choice, or a doctor recommends that strategy, why not try these products? The big "3" or as many as you can afford; to help w/ inflammation issues, etc. I don't see what the big whup is...they are pretty benign. Dont work, don't take them anymore.
does anyone know if the 25% decrease in RNA levels correlate to the general public who is not on the regimen? How did they make an observation that this decline is significant if it resembles what is seen in the non participating patients. Was there a control group?
Just curious, nothing more...;-]
Just curious, nothing more...;-]
Good point. A decrease in viral load is the least signifcant finding because it flucuates so wildly anyway. But the other findings are interesting. I'm just happy to see that someone is researching this. There's a lot of anecdoctal accounts of improvement from taking herbs/vitamins (including my own account) that warrant the undertaking of a serious research effort. This study was preliminary, but hopefully it will lead to more, and better designed, studies.
Susan
Susan
It's a no-brainer as far as I'm concerned. If you're going to opt for "watchful waiting," you'd better be doing something while you're passing the time.
This is where Jim and I seem to differ. He enthusiastically endorses the watchful waiting approach for folks with little or no fibrosis (like you and me), yet he clearly seems against herbs, vitamins and other supplements.
He apparently had a bad experience with them and now seems convinced that they're bad for everyone (in spite of the evidence presented in the study and the anecdotal evidence supplied by you, me and many others).
Jim, if you're listening, don't you think you're allowing your personal experience to color your thinking too much on this?
Susan
This is where Jim and I seem to differ. He enthusiastically endorses the watchful waiting approach for folks with little or no fibrosis (like you and me), yet he clearly seems against herbs, vitamins and other supplements.
He apparently had a bad experience with them and now seems convinced that they're bad for everyone (in spite of the evidence presented in the study and the anecdotal evidence supplied by you, me and many others).
Jim, if you're listening, don't you think you're allowing your personal experience to color your thinking too much on this?
Susan
Hi, just thought I'd post this, not a bad study from what I can see, but not the best either. Once again, only Interferon treatments rid people of the virus, but I thought my high anti-oxidant use did help me while I'm waiting to treat...as far as symptoms, apparently other people think so too.
Treatment of Chronic Hepatitis C Virus Infection via Antioxidants: Results of a Phase I Clinical Trial.
Melhem A, Stern M, Shibolet O, Israeli E, Ackerman Z, Pappo O, Hemed N, Rowe M, Ohana H, Zabrecky G, Cohen R, Ilan Y.
From the *Liver Unit, Department of Medicine, and daggerDepartment of Pathology, Hebrew University, Hadassah Medical Center, Jerusalem, Israel; and double daggerMarcus Foundation, Atlanta, GA.
BACKGROUND:: The pathogenesis of chronic hepatitis C virus (HCV) infection is associated with a defective host antiviral immune response and intrahepatic oxidative stress. Oxidative stress and lipid peroxidation play major roles in the fatty liver accumulation (steatosis) that leads to necro-inflammation and necrosis of hepatic cells. Previous trials suggested that antioxidative therapy may have a beneficial effect on patients with chronic HCV infection. AIMS:: To determine the safety and efficacy of treatment of chronic HCV patients via a combination of antioxidants. METHODS:: Fifty chronic HCV patients were treated orally on a daily basis for 20 weeks with seven antioxidative oral preparations (glycyrrhizin, schisandra, silymarin, ascorbic acid, lipoic acid, L-glutathione, and alpha-tocopherol), along with four different intravenous preparations (glycyrrhizin, ascorbic acid, L-glutathione, B-complex) twice weekly for the first 10 weeks, and followed up for an additional 20 weeks. Patients were monitored for HCV-RNA levels, liver enzymes, and liver histology. Assessment of quality of life was performed using the SF-36 questionnaire. RESULTS:: In one of the tested parameters (eg, liver enzymes, HCV RNA levels, or liver biopsy score), a combination of antioxidants induced a favorable response in 48% of the patients (24). Normalization of liver enzymes occurred in 44% of patients who had elevated pretreatment ALT levels (15 of 34). ALT levels remained normal throughout follow-up period in 72.7% (8 of 11). A decrease in viral load (one log or more) was observed in 25% of the patients (12). Histologic improvement (2-point reduction in the HAI score) was noted in 36.1% of the patients. The SF-36 score improved in 26 of 45 patients throughout the course of the trial (58% of the patients). Treatment was well tolerated by all patients. No major adverse reactions were noted. CONCLUSIONS:: These data suggest that multi antioxidative treatment in chronic HCV patients is well tolerated and may have a beneficial effect on necro-inflammatory variables. A combination of antiviral and antioxidative therapies may enhance the overall response rate of these patients.
PMID: 16082287 [PubMed - as supplied by publisher
Treatment of Chronic Hepatitis C Virus Infection via Antioxidants: Results of a Phase I Clinical Trial.
Melhem A, Stern M, Shibolet O, Israeli E, Ackerman Z, Pappo O, Hemed N, Rowe M, Ohana H, Zabrecky G, Cohen R, Ilan Y.
From the *Liver Unit, Department of Medicine, and daggerDepartment of Pathology, Hebrew University, Hadassah Medical Center, Jerusalem, Israel; and double daggerMarcus Foundation, Atlanta, GA.
BACKGROUND:: The pathogenesis of chronic hepatitis C virus (HCV) infection is associated with a defective host antiviral immune response and intrahepatic oxidative stress. Oxidative stress and lipid peroxidation play major roles in the fatty liver accumulation (steatosis) that leads to necro-inflammation and necrosis of hepatic cells. Previous trials suggested that antioxidative therapy may have a beneficial effect on patients with chronic HCV infection. AIMS:: To determine the safety and efficacy of treatment of chronic HCV patients via a combination of antioxidants. METHODS:: Fifty chronic HCV patients were treated orally on a daily basis for 20 weeks with seven antioxidative oral preparations (glycyrrhizin, schisandra, silymarin, ascorbic acid, lipoic acid, L-glutathione, and alpha-tocopherol), along with four different intravenous preparations (glycyrrhizin, ascorbic acid, L-glutathione, B-complex) twice weekly for the first 10 weeks, and followed up for an additional 20 weeks. Patients were monitored for HCV-RNA levels, liver enzymes, and liver histology. Assessment of quality of life was performed using the SF-36 questionnaire. RESULTS:: In one of the tested parameters (eg, liver enzymes, HCV RNA levels, or liver biopsy score), a combination of antioxidants induced a favorable response in 48% of the patients (24). Normalization of liver enzymes occurred in 44% of patients who had elevated pretreatment ALT levels (15 of 34). ALT levels remained normal throughout follow-up period in 72.7% (8 of 11). A decrease in viral load (one log or more) was observed in 25% of the patients (12). Histologic improvement (2-point reduction in the HAI score) was noted in 36.1% of the patients. The SF-36 score improved in 26 of 45 patients throughout the course of the trial (58% of the patients). Treatment was well tolerated by all patients. No major adverse reactions were noted. CONCLUSIONS:: These data suggest that multi antioxidative treatment in chronic HCV patients is well tolerated and may have a beneficial effect on necro-inflammatory variables. A combination of antiviral and antioxidative therapies may enhance the overall response rate of these patients.
PMID: 16082287 [PubMed - as supplied by publisher
Thank you very much for posting this. By the way, this study was published in the September 2005 issue of the Journal of Gastroenterology. I think it provides some compelling priliminary evidence that herbs (glycyrrhizin, schizandra, milk thistle, etc.) and vitamins (C, E, B complex, etc.) can yield some positive benefits for a significant number of HCV patients. Although I'm not part of the study, my own personal stats mirror the participants who experienced lower or normalized LFT's, lower viral load, and higher quality of life. The conclusion the researchers made is worth repeating:
"These data suggest that multi-antioxidative treatment in chronic HCV patients is well tolerated and may have a beneficial effect on necro-inflammatory variables. A combination of antiviral and antioxidative therapies may enhance the overall response rate of these patients."
Susan
"These data suggest that multi-antioxidative treatment in chronic HCV patients is well tolerated and may have a beneficial effect on necro-inflammatory variables. A combination of antiviral and antioxidative therapies may enhance the overall response rate of these patients."
Susan
Hi, you know it's not so much that I enjoy arguing w/ people and that I'm so invested in being right about this issue, it's actually nicer to avoid this issue so as to avoid confrontation, you might agree w/ me. Whew!!!!And I fully understand the concern on some people's parts that info like this can sway the "on the fencers" about treatment when perhaps they should do treatment (higher bx grades and such.) It's a scary disease and a scary treatment (for the uninitiated) and if people do need to take it; they need all the coaxing and positive reinforcement they can get. I understand that.
Still and all, the needs of other populations are important and need to be addressed as well. People who have been told that they can't do treatment due to contra-indications like cardiac probs, etc., multiple non-responders and relapsers, people who are early in the disease and/or have 0-1 damage and have been advised to wait for less harsh treatments, etc.
These people all might feel pretty cr%%py and need some possible relief, I know I feel better w/ the use of them, though it shows clearly in the study that not all well benefit. I figure if a person has the money (something else to consider, unfortunately,) it's worth at least a try. Quality of life and perhaps lowering inflammation are nothing to sneeze at. If it doesn't help, don't buy it anymore. Hope this helps.
Still and all, the needs of other populations are important and need to be addressed as well. People who have been told that they can't do treatment due to contra-indications like cardiac probs, etc., multiple non-responders and relapsers, people who are early in the disease and/or have 0-1 damage and have been advised to wait for less harsh treatments, etc.
These people all might feel pretty cr%%py and need some possible relief, I know I feel better w/ the use of them, though it shows clearly in the study that not all well benefit. I figure if a person has the money (something else to consider, unfortunately,) it's worth at least a try. Quality of life and perhaps lowering inflammation are nothing to sneeze at. If it doesn't help, don't buy it anymore. Hope this helps.
Oh darn! I was really hoping that your recent absence from the board meant that you were bouncing back quickly from treatment and that you were off on some great adventure. I guess that will have to wait a bit. Okay...let's shoot for the January 1st New Year for feeling terrific and thumbing your nose once and for all at all the residual discomforts of treatment. That gives you three more months to shake it off and start 2006 feeling fabulous. It'll happen for you Califia.
Take care,
Susan
Take care,
Susan
You sweetie, what a morale booster you are. Wish I _were_ starting a New Year. Much to my surprise, it's been one thing after the next since the end of tx three weeks ago--the latest is some kind of intense GI upset, which has been with me for a week now. Weirdly enough I remember something very similar happening after my first experience with interferon. I do believe it's all been related to tx withdrawal, which is disappointing when you just so badly want to move on. Looks like recovery is going to take some more patience! All my very best to you, your blondness.
Hi Califia,
It's always a pleasure to have you drop by. I hope you're doing well -- or at least better -- these days. I used to work at a major university, so September was always the true "New Year" for me. I'll bet it feels that way for you -- embarking on a new year without treatment.
Happy New Year, Califia. Cheers!
Susan
It's always a pleasure to have you drop by. I hope you're doing well -- or at least better -- these days. I used to work at a major university, so September was always the true "New Year" for me. I'll bet it feels that way for you -- embarking on a new year without treatment.
Happy New Year, Califia. Cheers!
Susan
Hello there. Popped in today to catch up on some of the ongoing controversies. So, hmmmm. Why_ would_ Dr. Berkson, whose rather decent CV is posted at Janis7, purposely use inaccurate SVR statistics to denigrate combo treatment? The answer is actually pretty clear. Berkson's study was published in 1999. This means it was probably submitted for review 1-2 years earlier than that, so we can safely assume that it was written in '95-'97. This puts it in the era of pre-pegylation, with the accompanying low cure rates. (Precisely why I wasn't retreating back then, and relying solely on herbs & antioxidants to control the beast.) Hope everyone is doing well.
Just wanted to say hi to everyone. I've been super busy. Been lurking and scanning, no time to write. You're all in my thoughts!
Lauren
Lauren
Once again, Califia to the rescue! I'd be too lazy to do all that (even though I suspected something like that) and I would of cleared things (at least that particular thing) in a manner a tad less "long winded" than is my wont.
that is the same statement that turned my attention off, although I am planning on re adding silymarin to my intake sometime in the future. It is funny how one sentence can change the whole feel of the article.
If the alternative drug makers wanted peer reviewed trials, they'd join the pharma formulary community to disclose the ingredients. Even if somebody is willing to spend money on research today, what does he test? Each company sells a different preparation.
I do understand and appreciate your intentions, and on reflection could have worded things in a more even manner.
But just to be clear, I'm not against milk thistle and/or antioxidants and would love to see more studies in this direction. Unfortunately, most studies are still funded by big pharmaceutical companies.
-- Jim
But just to be clear, I'm not against milk thistle and/or antioxidants and would love to see more studies in this direction. Unfortunately, most studies are still funded by big pharmaceutical companies.
-- Jim
I think you're overreacting to this, but I don't have the time or inclination to explain my intentions again. Have a good day.
Susan
Susan
Study said: "...There is no reliable and effective therapy for chronic hepatitis C since interferon and antivirals work no more than 30% of the time, and liver transplant surgery is uncertain and tentative over the long run..."
-----------------------------------------
I am not against milk thistle or antioxidants, they may indeed offer some protective effect on the liver, the jury is still out. What I objected to was the entire approach/slant, etc. of this "study".
It not only gives incorrect (or very outdated) information on SVR rates, but the statement on liver transplants is misleading.
The main problem with studies like this is that it can prevent some people who desperatly need combo treatment from seeking it.
-- Jim
-----------------------------------------
I am not against milk thistle or antioxidants, they may indeed offer some protective effect on the liver, the jury is still out. What I objected to was the entire approach/slant, etc. of this "study".
It not only gives incorrect (or very outdated) information on SVR rates, but the statement on liver transplants is misleading.
The main problem with studies like this is that it can prevent some people who desperatly need combo treatment from seeking it.
-- Jim
Hi Don, I love your screen name, it's like youre a pal of Zorro's or something, ha! Anyway, this trio is on a lot of lists as a good thing to take for any inflammatory disease. Along with maybe a multi-w/out iron, etc. If you want to try it, maybe go through a website that offers discout vitamins, like Puritan's Pride (they are really cheap though I've never tried them) I go through an outfit called Vitamin Shoppe, and their generics are pretty reasonable though not as cheap as Puritans. I just know them to be pretty good quality. I take more than that trio, but that's just me. If it doesn't help you say, after a few months, then you can always stop. Hope this helps.
Wow, congrats on getting good results on your labs. Even though liver enzyme tests do fluctuate do to many factors, if they are consistently normal already knowing what your bx grade is, that's A damn site better than consistenly high. Youre not the only one this has happened to, I know of many more, I think I'm going to try to get them to post here, ha ha! If I wasn't the age I am now, I would just keep doing the watchful waiting, but at 52 I better take the plunge (even though I secretly hope I could get into one of the protease inhibitor trials, it could happen!, ha ha)
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