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alcohol and interferon

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...

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Nicely said, As for AD's i've never understood why folks here encourage people to start on them even before starting TX. Alot of people never need them. Then you read from these same people that their still hooked on them long after ending their TX. and have bad experince's when they try to quit them. Maybe they feel because a Dr. writes a RX for them that their ok.... Maybe some day there will be a cure for hcv (i hope) and none of this will matter.
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Who here has “NOT” taken anything other than Interferon, Ribavirin, Aspirin products and Procrit during treatment? Can anyone post here and say that they have not taken any of the four items listed, if so lets hear it.

geterdone
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correction, should have read

have not taken anything Other Than the four items listed
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388154 tn?1306365291
I haven`t almust and only three of them no Procrit.

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
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Me either - no stone's here.  2nd week of tx daughter sent me 3 Vicodin for the bone crushing back pain but that's the extent of it.  No booze whatsoever!  No AD's
Trinity
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Please, I think AD's have a role to play as well.  I'm not on them myself, and I'm at Week 13 today.  Here's hoping I don't have to but it's an option that I'll take if I must. I just talked to a friend who's at Week 31 and has made it that far without them but now is feeling like he doesn't care if he lives or dies.  Not a good place to be and I suggested he talk to his doc about AD's.  Some people are already dealing with depression before they start treatment and since AD's take awhile to kick in, they start beforehand.  Many people on treatment talk about how hard the emotional component is and, indeed, in life, that is what can knock the knees out from under you, let alone on treatment.  Depression is always cited as a potential side effect of treatment that has to be dealt with and monitored.  I think AD's have their place and I sure wouldn't want anyone to feel badly for taking them.  Experienced treating doctors watch their patients for depression when on treatment.

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
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Excellent post
CS
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>the original poster really stirred it up here, Maybe that was intended.
---------------------------

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...

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
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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
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303646 tn?1214951327
I know someone who was on tx and started drinking on a friday afternoon, the reaction started around midnight and he was at the er at 2:00 am and was pronounced dead at
7:30 AM
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26471 tn?1211940121
This is my favorite thread that I've ever been a part of.  Debbie, Wellbutrin is a 3A4 substrate of P450, so it activates the enzyme.  I have already stopped taking this drug, but I am looking forward to a time when I might be able to take a protease/polymerase inhibitor.  The coming strategy for the inhibitors with interferon/riba seems to be boosting the bioavailability of either the Schering or Vertex drug, by using ritonavir, an HIV anti-viral that strongly inhibits 3A.  If I am taking other 3A4 drugs, I won't be able to take advantage of this strategy.

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.  

  
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475300 tn?1312426726
I also know someone who was not informed by the VA hospital about ADs.  He went in not feeling well at week 4 almost shot 5.  The VA told him to go home and have chicken soup.  He went home and hung himself.  True story, I was scared to death about the sucicide possibility.
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i just want to say  probably what every1 else has  said  i was an alcoholic for 14 years strait a case  a day (well still am an  alcoholic if you  understand but dont drink anymore )3.5  years  ago when going through rehab i was tested for hep c i was educated deeply about the importance of the absence of alcohol from here on out with hepc  no exceptions  ,wedding ,cough syrup , nothing  zippo not even a tiny glas of wine  1 im an alcoholic and 2 i have hep c with hepc YOU CANNOT DRINK ANY ALCOHOL IT WILL SPEED THE DAMAGEING EFFECTS OF THE HEP C VIRUS  if im wrong  some 1 please  clear  or add to this by the  way 1/20/05 sobriety date  i hope this helps its important dont mess around with it please
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>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.

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
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388154 tn?1306365291
You shouldn´t have been taking that last glass so maybe you would have awoided them
circles!!!

ca
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388154 tn?1306365291
I don´t care if others missunderstand as long as you dont do.
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LOL - enjoyed the laugh
CS
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Thank You!  For posting some common sense among the emotion...Some on this thread seem to be forgetting that you were giving a REAL reason not to drink while tx'ing...i.e. the interaction between the interferon and alcohol.  I read a lot on this forum and I never really knew that before.  Everyone just screams about how alcohol is throwing fuel on a fire, etc., etc.

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!
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Back in the day when I could have a few I would have loved to debate with you in one of the nice Aussie beer bars.  I'll bet you guys can get pretty heated up and I think it's quite entertaining.  Even though I don't agree with you I have to admire your enthusiasm.  I also read what you posted on Mike's thread about high iron and you just don't mince words, it's like what don't you get man, you don't have high iron.  Oh, CS gotta love ya.
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I knda like they way you handled Miles.
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
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Oh yeh
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.
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CS I am glad there are a few who remembered SB’s discussions on this topic and that if my memory servers me correctly there were NO heavy drinkers that counter posted back during those posts and as with any since then. I don’t think that there any heavy drinkers here today and if there were I doubt seriously that they would even think to post to one of these fire and brimstone threads even in a drunk state. Why? Because when you’re drinking or drunk you don’t want to hear the truth about drinking. I do not advocate drinking while on treatment but it is the person treating choice and there’s alone.

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.

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CS:  "And all I am saying is where is the evidence to support this? "
--------------------------------------------------------------------------------------------------------
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


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I just listened to a Vertex presentation and in the latest one they tallked about the demographics of heppers.  As we age we are dying off.  The number of deaths due to liver failure has doubled in the past 10 years.  It is going to increase tremendously unless people get treated and cured....and soon.  They used to forecast that only a small group of us would die from hep.  They mentioned that this is from the current issue of Hepatology.  Apparently the did a meta analysis of all the data out there and made a new analysis based on 30 years of infection instead of the old 20 years infected study.

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
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i live in the usa and i own a retail beer store, and really it sucks not to be able to have a few beers on the weekend, i have hep c 1a, 2/2...
..........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
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Below comes from http://hepcproject.typepad.com/hep_c_project/2004/03/alcohol_how_muc_1.html
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
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Bad reporting = flawed data  
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

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You're right.  : )

off to work.

w
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439168 tn?1307935340
I'm a visitor here on your community. I stop by to read your posts. It's very interesting. I have a family member with Hep C. I also work with transplant patients, mostly liver transplant patients. I'm learning so much about what my family member is going through and what I'm reading here. I was quick to say certain things about what was being posted. My family member with the Hep C put some things in perspective for me. It changes the way I view some of the things that my patients tell me now. We have transplanted numerous people that have recurrent Hep C and have an occasional beer or wine...even those who have had a prior transplant. Once they receive their organ, the go back to drinking occassionally, and then they go into rejection, usually requiring another transplant.

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.
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439168 tn?1307935340
Another thing to consider....Alcohol is NOT the only thing that can damage your liver. We put toxins in our body every day that taxes our liver. I read some of these posts and I wonder...are the people that are harping on those that have an occasional beer or wine also living a toxin free life? No cigarettes. No prescription meds. No over the counter meds. No tylenol. No coffee products. No red meat. Illegal drugs....The list goes on and on.

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.
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419309 tn?1326506891
Ashley:  thanks for the post.  Great commentary.  A most welcome visitor! :)

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
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http://pubs.niaaa.nih.gov/publications/arh27-3/232-239.htm

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.
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From the study link you posted
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
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"Drinking in moderation" when one has HCV"
----------------------------------------------------------------------------------


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


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calling people Nazi's should go
--------------------------------------------
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
----------------------------------------------
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).  
--------------------------------------------------
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?
---------------------------------------------------
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?
------------------------------------------------
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.  
----------------------------------------------------
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?
-------------------------------------------------
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
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            I think until I get back in town and just under 2 weeks it's a good point for me to break.  I dunno if this will have faded away by them.  It was interesting, sometimes fun, provoking(!!) and educational.  Thanks!!

Take care
Willy
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I am going away for two weeks too.
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.
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218926 tn?1398019846
My hepatologist and my internist both told me that alcohol counteracts interferon, and can provoke extremely unpleasant side effects with both interferon and ribavirin.

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/


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WOW! This is one of the best Alcohol threads I have seen on this site, a lot of good information from both sides of the isle, well debated by both side without all of the hard ego bolstering and great comments by all without getting into a all out ******* contest on all the various issues surrounding treatment and alcohol and why one should or shouldn’t drink while on or off treatment. Thanks! Willy50 and CookSparrow for your very informative discussion.

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
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Thanks Jasper,  (and CS again) I'm used to waking up with my ears burning or in fear of what I may have written.

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
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Yeah, I know more addictive than alcohol, lost count of the plastic surgeries to the side of the face, lol. Have a good trip and enjoy.

jasper
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http://www.wwwdotcom.com/
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408795 tn?1324939275
I think you really answered your own question, in a way.  You drank while on tx, felt the ill effects and hopefully for your sake, you don't do it again.  The question reminds me of this thought; I'm gonna go through tx so then my liver will be like brand new, then I can start using IV again and really tie one on.  At any rate, nothing I'm saying is meant to offend you in any way.  If you wanna hear the truth, tell what you did to your doctor, that should really give you an ear full.  Anyways, I appreciate your question and anyone who read it, knows that whatever their opinion on the action of drinking while on tx, it certainly took some big ones to ask the question.  Cocksparrow, I personally didn't see anything wrong with your answer to the question at hand, obviously some ppl got their feelings hurt from being called "alcohol nazi's".  Well you got your point across and that's what matters, anyone who read it in an unbiased manner could easily see that you wanted the poster to look and think "outside of the box".  "I more and more think that the 12step movement is spreading a lot of stupidity world wide", thanks for bringing up that point comeagain.  I hope your question was answered joel, it should have been with 80 something responses.  Here's to wishing you a sincere easier tx than you've had in the past, and the SVR you're working towards.  God Bless        
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what about drink alcohol after ending treatment of hep c (interferon)?
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You will get more responses if you start your own thread. Go to the top of the page and click on the green post a question button, you can title the thread and add a message.

I would guess that you would make a decision about drinking based on the condition of your liver and how much you want to drink. If you have advanced disease then drinking would not be in your best interest of course.

have you gotten to 6 months post treatment svr yet? You may want to take that into consideration.

take care - Dave
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1117750 tn?1307390169
oh the booze thread ;-)

i know someone who drank most days on tx and svr'd not saying its good or that i would but proves it does not prevent svr in all cases
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Hi,I agree with what your saying .In my experience i drank spirits like a trooper every day and weekend .I worked hard and ate well most of my life .I had Hep C for 25 years before i was fortunate enough to go on tripple therapy .In retrospect im lucky ,but having said that life style always has the last word .......when i considerother drugs your doctor will put you on in the course of your life I really dont think from what ive seen in drug users that a few drinks will make a impact alone .I like a drink but i put back .  
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This thread is 4 and a half years old but pretty much everything remains relevant.  No rules of biology or physics have changed since then that I am aware of.

The trip I took at the end of this thread was to get into a phase 3 Vertex Telaprevir trial.  I traveled 1000 miles, was accepted, got my biopsy and found I was a stage 1/6.  I declined to treat.  I'm just now trying to get into newer trials.

Cocksparrow went from this forum to Nomads, finished his treatment and cleared.  He remains with some damage from his treatment.  He also remains a student of things which pertain to HCV and treatment.  He started his own forum which has an abundance of discussion about post treatment side effects of SOC.
If the link doesn't print you can google HCV wanderers.
http://***********.org/forum/index.php?sid=e23c7fb322592cbab190fe8e13f9367d

So far as commenting on this thread....... when I was recently seen to gain access to a trial the use of alcohol was one of the concerns.  I believe that it remains to be considered by doctors as important.  If you show up and tell them it isn't, even to argue just how much might not be harmful...... you are merely only going to make yourself look as though you don't care about your outcome or your health.  I do not myself want to be in that boat.

After successful eradication of HCV is another story, but keep in mind that some people take a year or two for their livers to improve.  Remember also, some cirrhotics may not appreciably improve.

willy
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1746242 tn?1318213302
I swear every time I get on this forum someone is asking this?  The first thing I was told was diagnosed was don't even have one drink. Someone would love having your spot to do treatment. If you can't stop drinking then don't treat. Kill your liver and enjoy drinking till you die!
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