Aa
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
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
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
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
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
..........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
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
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
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".
--------------------------------------------------------------------------------------------------------
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
--------------------------------------------------------------------------------------------------------
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".
--------------------------------------------------------------------------------------------------------
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
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.
jasper
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.
jasper
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.
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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