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Avatar universal

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...

Feedback please
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1746242 tn?1318209702
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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Avatar universal
wow
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Avatar universal
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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Avatar universal
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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1117750 tn?1307386569
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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Avatar universal
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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Avatar universal
what about drink alcohol after ending treatment of hep c (interferon)?
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408795 tn?1324935675
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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Avatar universal
http://www.wwwdotcom.com/
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Avatar universal
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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Avatar universal
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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Avatar universal
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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218926 tn?1398016246
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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Avatar universal
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.
CS
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Avatar universal
            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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Avatar universal

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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Avatar universal
"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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Avatar universal
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
CS
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Avatar universal
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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419309 tn?1326503291
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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439168 tn?1307931740
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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439168 tn?1307931740
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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Avatar universal
You're right.  : )

off to work.

w
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Avatar universal
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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