SUPPLEMENTS FOR HEP C AND LOW PLATELETS

[MAX C.]

Are there any supplements, vitamins, etc that will assist the liver in combating hep c and to help with low platelets. I have been in 2 clinical trials of interferon and ribiviran without success.

Also can you comment on any kind of alternative treatment for Hep C, if not to cure, then to keep the viral load down. Possibly chinese medicine and herbs.

Thanks

[fingernails]

i'm finish treatment i throught it was the happiest day of my life , but instead , now i have to deal with this low plateletes so they got me on vitamin b12 and d god i pray this problem will inprove im due for a hand opp, and cant get it done because i can bleed out and die im so afraid i dont no what to do  hey i need all the preys i can get good luck to you take care .

[Renee543]

I can identify with this because I too start diving into supplements and alternative txt as soon as I found out I had hepc in 1995. I have managed to be healthy and symptom free for many years...BUT I am now in the same place. I guess even if you can keep it from progressing for 15-20yrs. there will come a point when it is not enough. I went in for a simple OB surgery and was canceled because my platelets were low and my INR not good. Had bloodwork done and found out my IRON levels were very high. So though I do not feel bad, things are going on and I would not have know if I hadn't planned surgery. Because I was totally going by what my biopsy said from a year ago Stage 2 fibrosis. I have had an ultrasound too and it was ok...but now I just had a CT done and my left caudate lobe is a bit enlarged and so is my spleen on the high side of normal. So like you, I feel I am going to have to be proactive and make a good decision. I do not want to do txt, as I am sure nobody that has done it ever wanted to. I am also a 1A. But I see my liver doc this week and will discuss the whole thing with him, I can already hear him telling me to get txt, he wanted me to 2 yrs ago when my numbers were much better.
As scared as I am and sometimes I think we can read too much and get too much info, I feel I am at that crossroads now where I have to choose and if I have to choose between txt and liver cancer.....well.....no brainer. I only hope I did not wait too late because of my low platelets....I am not sure if I can qualify for txt. Does anyone know?
It's a very personal decision to make but I feel when pushed in a corner there is really not too many ways out. I welcome input from anyone who is in this situation or anyone who has been thru it and did the txt. thanks

[honey1616]

Sorry to hear that tx did not work on you and yes it can be rough going through it,,,,Did you have a biopsy before starting your tx and did you respond at all to the tx at 3 month mark?  I wish you the best in fighting this disease!

[Califia]

I am on tx now, but credit TCM with halting fibrosis progression for 14 years and keeping my liver function optimal while under viral assault.   Dr. Zhang in NYC is a brilliant practitioner, as is Misha Cohen, OMD, with whom I've been treating since my negative experience with Intron-A in '90.   Typing is difficult & I don't want to get too wordy, but you might want to check out her _Hepatitis C Help Book_ , and her website at  docmisha.com.    Has a list of practitioners nationwide trained in her HCV protocol,  which is similar to that of Dr. Zhang.  Go for it!

[MAX C.]

califia............Are you on peginterferon now?  Do you know your genotype? Has your viral load decreased?  Hope your treatment goes well. It is hard, I have done it twice.

[MAX C.]

I am a nurse and have kept up on current treatments etc. The previous failed therapies of interferon and then interferon with ribaviran are probably due to the genotype 1a that I have. It does not respond well to the current marketed therapy. I have been in good health until this year, things are starting to come to the forefront. Weird joint pains, itching, rashes, now low platets and slight liver enlargement. This has me considering what to do at this point. I have an appointment with a hepatologist who will probably want to do a liver bx, but I would think this is where the low platelets might come in handy. I guess God does have a sense of humor.  I have come across a book by Dr Qingcai Zhang MD "Healing Hepatitis C with Modern Chinese Medicine." He uses herbs to lower viral load and inflammation which may not get rid of the Hep C virus but minimize damage and help the immune system fight back. I am considering this versus traditional Peginterferon. The treatment I had before made me very, very sick and I am not looking forward to jumping in that arena again unless I am faced with no other choice.  I am wondering if anyone out there has had any experience with this or any other therapy that may contain this virus to minimize damage to the liver, ...............thanks

[cuteus]

I would find out the liver damage stage before doing alternative stuff, if your disease has damaged your liver beyond stage 1, no more than 2, I would give conventional therapy another shot. You don't know how fast it might progress and at stage 2, there might not be a lot of leeway to play with.
i am hoping to be an ex 1a, I will know in January if 72 wks of pegasys/copegus made me an ex.  It was not a joy ride, but it was manageable.
good luck

[Califia]

I agree with you--and just for the record my fibrosis stage has been steady btwn 2 and 3 for all this time.   Right on the knife's edge.

Max, I'm 1b and responding extremely well on tx.  Thanks for your well wishes, and same back at you.

[snook_man]

I am 27 yrs old. I have genotype 1a, VL of 4000 last test. I have had the virus since birth, as mom has same geno, and my liver was staged at 2/3.
My ALT's have always been around 100-120. VL was around 5462. I started a heavy supplementation protocol, and within 4 months, stabilized my ALT's to 60, knocked my AST's within range at 32, dropped VL to 4000, and increased over all CBC's. Platelets went up from 165, to 218. Dr was amazed at the progress I made, and made me write down everything I had done and was taking. There ARE many sites and reference books to get info on halting further liver progression with supplements. Again, no other cure than conventional, but supplements definately are an alternative. I am currently on week 6/48 of pegysus/riba cocktail, and crusin along. My WBC dropped from 6.4 or so to 2. But my RBC have stayed stable. Alts went up from 60 to 113 at week 2, to 83 at week 4. I don't find out if drugs are working till week 12.

Califia is definately a story in herself as she kept her liver from progressing for over 14 years with supplements alone. You really need a biopsy to see where you are at right now. And that should be the determining factor. Good luck!

[bystander2002]

(thats not from the amer. liver foundation)

[silvermoon]

THIS info was given to me by a friend,,it is form the American Liver foudation  I can't fiind the link, I had it copied ans aved to file..
do searches..  but the guideline*** towards the end of this as to supplements, etc..  is excellent for healing/managing cirrhosis..and all that goes with it..  keep the Vit E to 200mg/day though..  I take 1000mg Milk thistle daily/ but have to stop that once I start Tx.. it interferes with the interferon..
also yogurt is GOOD for your whole system,.with the digestion enzymes, with non animal proteins,,calcium.
and it can help to keep some of the drug complications( thrush, yeast infections, etc.. at bay  and proteins are important for platelets  and blood building!!  but animal proteins are hard on yor liver...  anyway.. good luck...  do alot of research and look back at why Txs failed for you.. there maybe a reason, or there may be none..  but try again...don't ever give up.. take care...

-----------------    ------------------- --------------
Vitamin E
Vitamin C
Milk Thistle - Silymarin
Amino Acids (I use a product called Protivity)
Antioxidants -
Alpha Lipoic Acid
NAC
B Vitamin Complex
*And I'm a huge fan of a super Antioxidant blend
called Microhydrin PLUS


Things to Avoid:
Vitamin A
Fats
Sugars
IRON!
Processed Foods
Insecticides / Pesticides
Chemicals
*and beware of chemicals at work etc that are
absorbed through the skin & beauty supplies
Valerian Root
Clove
Alcohol


Abstracts For Protocol
   The Liver
The liver is the largest organ (about the size of a football and averaging about 3.5 pounds), and has more functions than any other human organ.
A person's entire blood supply passes through the liver several times a day, and, at any given time, there is about a pint of blood there.
The liver produces and secretes bile (to be stored in the gall bladder until needed)  that is used to break down and digest fatty acids.
It also produces  prothrombin and fibrinogen, both blood-clotting factors, and heparin, a  mucopolysaccharide sulfuric acid ester that helps keep blood from clotting within the circulatory system.
The liver converts sugar into glycogen, which it stores up until the muscles  need energy, when it is secreted into the blood stream as glucose
. The liver  synthesizes proteins and cholesterol and converts carbohydrates and proteins into fats, which are stored for later use. It also produces blood protein  and hundreds of enzymes needed for digestion and other bodily functions. As  it breaks down proteins, the liver also produces
urea, which it synthesizes  from carbon dioxide and ammonia. (Urea is the primary solid component of  urine, and is eventually excreted by the kidneys.)
The liver also stores  such critical trace elements as iron and copper as well as vitamins A, D, and B12.

Cirrhosis
Cirrhosis of the liver is a chronic, diffuse (widely spread throughout the organ), degenerative liver disease in which the parenchyma (the functional  organ tissue) degenerates, the lobules are infiltrated with fat and structurally altered, dense perilobular connectivetissue forms, and (often)  areas of regeneration develop.
The first scientist known to have diagnosed  the disease was Gianbattista Morgagni, who published 500 autopsies in 1761.  
Laennec named the disease in 1826, using the Greek word for orange color  because cirrhotic livers turn a yellowish to tan color.
Cirrhosis is the seventh leading cause of death by disease in the United  States with about 25,000 dying from the disease each year (down from 50,000  in 1979).
About a third of cases are compensated, meaning there are no clinical symptoms. Such cases are usually discoveredduring routine tests  for other problems, or during surgery or autopsy.
In most cases, though,  there is a loss of liver cell function, and an increased resistance to blood flow through the damaged liver tissue (a condition known as portal  hypertension) leading to esophageal varices (enlarged, swollen veins at the  lower end of the esophagus).
Severe cirrhosis leads to ammonia toxicity,  hepatic coma, gastrointestinal hemorrhage, and kidney failure. As liver cells are destroyed, they are systematicallyreplaced by scar tissue.
Symptoms
Symptoms of cirrhosis include:
nausea or indigestion and vomiting,
constipation or diarrhea,
flatulence,
anorexia,
weight loss,
ascites (the  accumulation of serous fluids in the peritoneal cavity),
light-colored stools,
weakness or chronic dyspepsia,
dull, aching abdominal pain,
varicosities, nosebleeds, bleeding gums,
other internal and external bleeding, easy bruising,
extreme dryness of skin,
and spider angiomas.
Psychotic mental changes such as:
extreme paranoia can occur in cases of advanced cirrhosis.
Other symptoms are:
testicular atrophy,
gynecomastia  (enlargement of the male breast),
and loss of chest and armpit hair.
Complications
When blood flow in the cirrhotic liver is estricted, blood can "back up" in  the spleen, causing enlarged spleen and sequestered blood cells.
Typically  in this condition the platelet count falls, and abnormal bleeding can result
. In extreme cases blood can actually flow backwards from portal  circulation to systemic circulation, leading to varicose veins in stomach  (gastric varices), esophagus (esophageal varices), and rectum (hemorrhoids).
Ruptured varices bleed massively and are often fatal.
Bilirubin levels may build up in the blood, causing jaundice and bright yellow to dark brown  urine.
Cirrhosis can also cause insulin resistance and diabetes mellitus.  
Because of inadequate filtering of blood toxins, brain injury can result.
Such brain damage can have symptoms that range from:poor concentration to  coma, swelling of the brain, stupor, and even death.
Cirrhosis is often associated with osteomalacia (the adult form of rickets, a softening of the bones that often leaves them brittle) and osteoporosis (a reduction in bone  mass).

The Alcohol Factor
The most common cause of cirrhosis is believed to bealcohol (ethanol) abuse  (about 10% of American men and about 3% of American women chronically abuse  alcohol). Though it affects many organs, alcohol is especially harmful to  the central nervous system and the liver, and is a factor in about  three-fourths of the cases of cirrhosis in the United States.
Alcohol must  be metabolized, and the liver performs most of that job, suffering serious  damage in the process. Not only does alcohol destroy liver cells; it also  robs them of their ability to regenerate.
Such cofactors as hepatitis C virus can increase the risk of cirrhosis in those whose intake of alcohol is excessive.
Alcohol-induced cirrhosis is  among the ten leading causes of death in the United States.
Women are at  much higher risk for drinking-related cirrhosis than are men. This may be  true because less of the alcohol consumed is metabolized in the stomach in  women before being absorbed into the blood stream.
Autopsies indicate that  from 10 to 15% of American alcoholics suffer from cirrhosis at the time of  death. About a third of those consuming one cup to one pint (8 to 16 ounces)  of hard liquor per day (or the equivalent in other drinks) over a15-year  period will develop cirrhosis.
In addition to cirrhosis, alcohol abuse can lead to fatty liver, which can  lead to stearohepatitis (or steatohepatitis, the older term), scarring of the liver, and eventually to cirrhosis.
Overuse of alcohol can also lead to  acute, chronic hepatitis.
Complications can include:
liver dysfunction,  
abnormal blood clotting,
jaundice,
and hepatic encephalopathy (neurological  dysfunction brought on by failure of the liver).
Chronic abusers of alcohol often need significant vitamin supplementation to correct vitamin deficiencies caused as much by neglect and poor eating habits as by damage  from the alcohol. An acute thiamin (vitamin B1) deficiency is typical.

Other Risk Factors and Causes
Cirrhosis patients are at high risk for obesity, fatal bacterial infections,  stomach ulcers, kidney problems, gallstones, and diabetes mellitus.
They are  also at increased risk for liver cancer.
Risk factors for cirrhosis include:
  nutritional deficiencies (lack of proteins, vitamins,
choline, trace  elements, or methionine),
hepatitis (B, C, or D)
and other bacterial and  viral infections,
and severe reactions to prescription or "recreational" drugs.
Vitamin B1 (thiamin) deficiency may directly cause alcoholic  cirrhosis.
One study concluded that vitamin B1 deficiency is a greater risk  factor for liver cell death than heavy alcohol
consumption.
Congestive heart failure and poisons (including alcohol, phosphorus, and  carbon tetrachloride) pose a serious threat to the liver and can lead to  cirrhosis.
Genetic disorders, inherited metabolic diseases such as  hemochromatosis (marked by excessive iron absorptionand accumulation) and  Wilson disease (in which the liver stores too much copper), advanced syphilis, exposure to blood flukes, other parasitic infections (such as  schistosomiasis), and blocking of the common bile duct are all factors which  can lead to cirrhosis.
Liver injury from an accident or from cystic fibrosis  can also bring on cirrhosis.
Diagnosis
Positive diagnosis of cirrhosis must be made by liver biopsy, but X-ray,  blood tests, and physical examination are all used in diagnosis, as is  observation of the symptoms mentioned earlier. CAT (computerized axial tomography) scans, radioisotope liver scans, and ultrasound can all be used  to diagnose cirrhosis.
Early diagnosis is critical in order to establish the  cause of the disease and determine the amount of damage to the liver.
Two symptoms of cirrhosis are the loss of healthy, functioning liver cells  and the scarring and distortion of the liver that eventually take place. As  fewer cells function, less albumin (a protein) ismanufactured.
Lowered  albumin levels permit retained water (edema) in the legs and abdomen  (ascites). Easy bruising and bleeding result, and, in some cases, vomiting of blood. Intense skin itching can also result from excessive bile product  deposits in the skin, often accompanied by jaundice or yellow skin.
Gallstones are more likely to form in cirrhosis patients because there is  not enough bile reaching the gall bladder.
Toxins that the liver would  normally remove build up in the blood, dulling mental functions and bringing  on personality changes.
Drugs the patient is taking, normally filtered out  and disposed of in urine, may remain in the bloodstream for a much longer  period and act longer than expected or even build up in body tissue.
A liver with cirrhosis is usually much larger than a healthy liver

Precautions and Prevention
Once cirrhosis has been diagnosed, sodium and fluids should be restricted,  and all alcohol consumption must cease. Antiemetics, diuretics, and  supplemental vitamins are prescribed.
Cirrhosis patients should avoid  straining at the bowel, violent sneezing and coughing, and nose blowing, and  should use stool softeners as prescribed by a qualified medical caregiver.
Untreated cirrhosis can be fatal, and patients should avoid exposure to  infections and eat small but frequent meals of nutritious foods, carefully  following caregiver instructions.
The liver is the only organ that can  generate healthy, new tissue in response to injury or disease.
It is therefore possible to regenerate a cirrhosis-damaged liver if extraordinary  therapies are followed and the underlying cause of the cirrhosis is  eliminated
More than half of all liver disease could be prevented if we acted on the  knowledge we already have. Avoiding or limiting the use of alcoholic  beverages is a good place to start.
That alcohol destroys liver cells is  well documented.
Man-made chemicals also pose an extreme threat to the  liver, so take recommended precautions.
Remember that all ingested, inhaled,  and absorbed toxins must be processed by the liver.
When working with  hazardous chemicals use adequate ventilation; follow product instructions;  do not mix chemicals; wear protective clothing and breathing equipment;  avoid inhalation and ingestion of hazardous
materials; avoid skin contact  and flush (wash) affected areas immediately; call your poison control center
or your emergency number (such as 911).
A complete listing of toll-free  poison control center numbers can be obtained online
[http://www.medicinenet.com/Script/Main/hp.asp].

  Treatments
When varices result, they can be treated with a reduction of salt intake and  diuretics, which help eliminate excess salts and fluids from the body.
Coma  and encephalopathy are treated by a reduction of  protein intake, and  hemorrhage from varices can be stopped by sclerotherapy (injection of a  scarring chemical into the bleeding vein).
Varices can also be compressed by  the use of a special balloon that is inflated around the enlarged vein,
squeezing the vein as it is inflated.
There is a new procedure (using  radiology) known as transjugular intrahepatic protosystemic shunt (TIPS)
which shows some promise.
Interferon-alpha, a powerful antiviral, may reduce the risk of cancer in  some cirrhosis patients.
In cases of total liver failure, transplantation  has been successful. Over 80% of liver transplant patients are still alive 5  years after the surgery.  
Japanese researchers found evidence that malotilate  prevented damage to liver cells and cirrhosis they attempted to induce in  rats.

Natural Therapies
The liver can often perform its essential functions in spite of serious  damage. It also has more ability to self-repair than do most other organs.
It is mportant to give the liver the nutrients it needs to function and be  able to regenerate and detoxify itself. Research done at the Center for  Biomedical Research at the Hospital of St. Joan in Reus, Spain, in 1992  shows that supplementation of zinc lessens the effects of fibrogenesis in rats in induced cirrhosis. German research shows that zinc deficiencies are implicated in liver cirrhosis and conclude that zinc substitution should be  provided to all cirrhosis patients when deficiency and corresponding  symptoms are found. (Long-term supplementation of zinc should not exceed 90  mg a day.)
Selenium deficiencies have also been found in the blood of  cirrhosis patients, leading to recommendations for selenium supplementation.
Ursodeoxycholic acid, a widely tested bile acid, has been found effective in  slowing the progress of cirrhosis, preventing gallstone formation, and preventing the formation of varices.
Research has shown decreased blood serum levels of vitamins E and K1, and  increased levels of vitamin A and iron in some cirrhosis patients.
These  patients should not directly supplement vitamin A or beta carotene, and  should also avoid niacin (vitamin B3) and supplements containing extracts  from the chaparral shrub. (Some research found absolutely no correlation  between cirrhosis and vitamin A levels in the liver and concluded that  cirrhosis patients were not at increased risk from vitamin A  supplementation, while other studies showed decreased vitamin A levels in  cirrhosis patients.
More research is needed, but cirrhosis patients should  consider vitamin A supplementation only under direct medical supervision.)  Japanese studies showed that moderate intake of caffeine (in coffee) helped  to counteract some of the negative effects of alcohol on the liver.
Consumption of caffeine in green tea showed no such effect.
In Russian studies supplementation with ascorbic acid (vitamin C) and  alpha-tocopherol (vitamin E) improved the liver function of chronic liver  disease patients.
In a 1998 American study it was found that a high level of  supplementation of vitamins B2 (riboflavin) and B12 (cyanocobalamin and  hydroxycobalamin, associated with folate metabolism) reduced the risk of
cirrhosis associated with alcohol consumption above 50 grams (1.75 ounces) a  day.
Recommended supplements for a seriously damaged liver are:
the amino acids :acetyl-L-carnitine, (1000 mg per day),
N-acetylcysteine (600 mg twice per  day),
L-arginine (5 to 10 grams per day),
leucine (1200 mg per day),
isoleucine (600 mg per day), and valine (600 mg perday).
Silymarin (at about 300 mg per day) is effective in cirrhosis patients, even in alcoholic  liver cirrhosis.
It is especially helpful for diabetics with cirrhosis  because it reduces the lipoperoxidation of cell membranes and insulin  resistance, decreasing the need for insulin supplementation.
L-Arginine (up  to 5 to 10 grams a day) and glutamine (2000 mg per day) are most effective when there is still at least 20% liver function. (L-Arginine should be taken  under a doctor's supervision.)
Because ethanol damages the liver at least in part by the generation of free  radicals, and because it depresses an enzyme needed to convert methionine  into SAMe (S-adenosylmethionine), SAMe supplementation can help regenerate  normal liver function.
Periodic blood testing is required to monitor the  effectiveness of patient therapy.
Doses of 400 to 800 mg twice per day have  shown promise in reversing alcoholic cirrhosis.
A less expensive alternative  is twice-per-day supplementation with 500 mg of TMG (trimethylglycine, or betaine), folic acid (800 micrograms), and vitamin B12 (500 micrograms per  day).
Supplementation with phosphatidylcholine (2000 milligrams per day) may  provide protection against alcohol-induced septal fibrosis, cirrhosis, and  lipid peroxidation.
  Because anemia is a common complication in cirrhosis patients, iron  deficiency is a possibility.
Iron supplementation should only be used under  direct medical supervision with close monitoring
because excessive iron can  cause severe liver damage, especially when combined with alcohol, porphyrogenic drugs, or chronic viral hepatitis.
Iron can also enhance the  disease-producing abilities of viruses, adversely affect immune function,  and enhance fibrogenic pathways, all of which may increase liver injury.
Iron may also be implicated as a co-carcinogen or promoter of hepatocellular  carcinoma, even in patients without hepatitis C or cirrhosis

Ongoing Research
There is a large amount of research and study into causes and cures of  cirrhosis of the liver. Patients and healthcareproviders should stay  abreast of research findings for the latest developments in cirrhosis  treatment and therapy.

Summary
Cirrhosis of the liver can be caused by excessivealcohol consumption,  accidental, bacterial, or viral liver damage, exposure to toxic chemicals,  and severe reaction to prescription or"recreational" drugs. Supplementation  of antioxidants, branched-chain amino acids, an all except B3 (niacin), of the B complex of vitamins has been shown beneficial.
For specific anti-viral  therapies to help eradicate hepatitis B or C, refer to our Hepatitis B and  Hepatitis C protocols.
Drink alcohol in moderation if at all. If diagnosed with cirrhosis, do not  drink.

*** Studies on alcoholic cirrhosis patients have shown benefits from supplementing valine, leucine, and isoleucine.
These branched-chain amino acids can enhance protein synthesis in liver and muscle cells and are used  by body builders to produce an anabolic effect.
Four capsules of Branch  Chain Amino Acids (free form) provide 200 mg of
L-leucine, 600 mg of  
L-isoleucine, 600 mg of L-valine,
and 10 mg of vitamin B6 (pyridoxine).
The  suggested dose is 2 to 4 capsules per day between meals with fruit juice or  before eating. Warning: These capsules are only to be used by adults who are  fully grown, and not by anyone afflicted with pellagra.
  Patients with depleted SAMe levels should take from 2 to 4 200-mg tablets a  day, spread throughout the day.
Patients must adhere to physician-prescribed  blood testing schedules to assess the effectiveness of this therapy.
A cost-effective alternative to SAMe supplementationis TMG (trimethylglycine), also known as betaine.
The suggested dose is one capsule  after meals, twice per day, or as directed by a physician. (Each hard
gelatin capsule provides 648 mg [10 grains] of betaine HCI and 130 mg [2 grains] of pepsin NF [1:10,000].)
Do not take this supplement on an empty  stomach. Betaine HCI is well tolerated by most highly allergic individuals.
The vitamin B complex is extremely important for liver health; therefore
daily supplementation of :
vitamins B1 (500 mg),
B2 (75 mg), B5 (1500 mg),
and  B6 (200 mg) is strongly recommended
(though vitamin B3 [niacin] should be  avoided by cirrhosis patients).

Other recommended daily supplements are :
1500 mg ofcholine,
1600 mg of folic  acid,
500 mg of vitamin C,
800 IU of vitamin E,
300 micrograms of selenium,
and 100 mg of coenzyme Q10 (for its antioxidant an blood-flow-enhancing  properties).
  Acetyl-L-carnitine should be taken in two daily doses of 1000 mg each.
Take  two 600-mg doses per day of N-acetylcysteine.
Drink green tea,
or take 4 to  10 standardized 100-mg capsules of green tea extract per day to lower toxic  levels of iron (which may exacerbate free radical damage to the liver).
Five to ten grams of L-arginine
and 2000 mg per day of glutamine may help  lower blood levels of toxic ammonia permitted to build up by a damaged  liver.
L-Arginine can help facilitate liver regeneration if the liver is  still at least 20% effective
Silymarin treatment (about 300 mg per day) is appropriate for all alcoholic  liver disease patients, and has reduced insulin resistance in diabetic patients with cirrhosis.
  Zinc should be supplemented in cirrhosis patients at a rate of at least 12  mg per day (not to exceed 45 milligrams a day),
while selenium should be  supplemented according to your doctor's instructions. Warning: do not take
high levels of these trace elements without directmedical supervision as
high levels of zinc intake cause copper deficiency,
and selenium reaches toxic levels at about 800 micrograms per day.

For more information: Contact:
the American Liver Foundation,
800-223-0179.
Product availability: SAMe; vitamins B1, B2, B5, and B6; folic acid; choline; vitamins C and E; coenzyme Q10; acetyl-L-carnitine,  N-acetyl-cysteine, green tea, L-arginine, curcumin, silymarin, and th branched-chain amino acid complex (valine, leucine, and isoleucine)


JOVO/ALT.