supplements Cocksparrow took on his 3rd succesful TX try

[evangelin]

I found that this was actually in Gauf's journal here on Medhelp so I decided it would be OK to post it.  CS and Cowriter  did a lot of study to come up with this and it includes those OK'd by HR.  There is a ton of lengthy explanation about the research which helped him to decide on this plan but it is so long, it can be found in Gauf's journal.  I don't know if CS stayed with all of these the whole way through or if he improvised a long the way.  I know he intended to take Alinia but found he could not tolerate the SX. I think the SAM-E /TMG and the supportive vitamins for them were the stars in his plan.  It worked for a three time non responder so it surely deserves some attention.  
There was another major part to his plan involving the reduction of insulin resistance before starting TX .  I'm still hoping Cowriter will come around to comment.She doesn't show up often but the insulin resistance issue is her specialty.  I know that Willing has studied his plan also and his insights are always good too.  Maybe he will happen by.  You never know. This may not be an answerable question but I would like to know if these will all be valid aids if a protease inhibitor is added.  I know with Joe, the big problem will still be his poor response to interferon so I'm thinking probably so.

Cocksparrow's /Cowriter's plan:



Supplements I Intend taking during Tx:
During Tx........Dose..................Comments.....................Reason
SAMe.............1600mg BID..........S-Adenosyl-L-Methionine.....Interferon Signaling
TMG (Betaine)...5 grams BID.........TriMethylGlycine...............Interferon Signaling
ALA...............600 mg BID..........(Alpha Lipoic Acid)............Antii-Oxidant/Insulin Sensitiser
NAC...............2 grams BID.........(N-Acetyl Cysteine)............Antii-Oxidant/Insulin Sensitiser
Taurine...........1000mg BID...........................................Antii-Oxidant/Insulin Sensitiser
CoQ10............200mg...............(Co Enzyme Q10)...............Antii-Oxidant
Vitamin C..................................................................Antii-Oxidant
Vitamin E..................................................................Antii-Oxidant
Vitamin D3................................................................Immune system
Vitamin B12...............................................................SAMe & TMG CoFactor
Vitamin B6................................................................SAMe & TMG CoFactor
Folic Acid..................................................................SAMe & TMG CoFactor
Multi Vitamin – no Iron)
Probiotic

[Cory255]

Thanks for sharing your valuable research information.  It's especially good to know PI's fix MAVS.  

Cory      

[merryBe]

thanks for that...makes sense to me!!!

check your PM's

[evangelin]

I have saved this post for my arsenal.  
I actually meant that I would start a little Sam-E fund.  I had a very sweet and generous person gift Joe with a bunch of Sam-E and he has been taking it steady for a while.  I have kept all reserves in the fridge and they are in blister packs also.  We haven't had use of our crisper drawers for years because they house supplements!  I miss them but don't see getting to use them anytime soon. :>)
I've never seen that study about B vitamins but I'm so glad you posted it.  
Thanks and Happy Thanksgiving,
Ev

[Trish77]

There is a woman in my support group, showed up for the first time this month.  She is diabetic and on treatment.  She's early in the game, not at 12 weeks yet and I don't recall how far in. What she said about her viral load was confusing but enough to know that it doesn't seem she's responding well and has me concerned about her 12 week results. I'd like to know if taking anything now at this point would help change this.  

[CoWriter]

"I'm a little puzzled as to why you all settled on the extra B12 what with the high protein diet?? Usually high protein means adequate B12 assuming a normal GI tract"
---------------------------

Several reasons...

1.  Hep C causes depletion of B vitamins.
2.  Peg/Riba treatment decreases B vitamins.
3.  You need B vitamins to make serotonin.  We hoped taking B vitamins would help prevent depression.  
4.  Because studies have shown that Vitamin B12 is important for viral suppression.
5.  You need B vitamins for SAMe to work.  
6.  Because we were planning to use Metformin if his HOMA didn't go below 2 and Metformin can decrease Vitamin B12 and Folate when used long term (a study showed that after using Metformin for 4 years, 7% had decreased levels of Vit B12..


So if Hep C lowers Vitamin B.....and treatment lowers Vitamin B...and the Metformin you're taking lowers Vitamin B, and higher levels are associated with treatment success, then it makes sense to supplement it.

Co


Vitamins B depletion, lower iron status and decreased antioxidative defense in patients with chronic hepatitis C treated by pegylated interferon alfa and ribavirin.

Lin CC, Yin MC, et al, Clin Nutr, 2008 Nov 28; Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung City, Taiwan, Republic of China.

Summary: In a study involving 152 healthy subjects and 109 patients infected with hepatitis C (HCV), treatment with pegylated interferon combined with ribavirin was found to decrease levels of vitamin B6, vitamin B1, vitamin B2 and iron. Infection with HCV was associated with reduced levels of vitamin B6 and folate, and the drug treatment further diminished B vitamin status, and was associated with a higher percentage of patients with insufficient iron status. Furthermore, HCV infection was associated with higher plasma levels of malondialdehyde and 8-isoprostane; drug treatment for HCV further exacerbated lipid oxidation. HCV infection was also associated with significantly lower vitamin C and glutathione levels; drug treatment was found to reduce alpha-tocopherol level and activity of glutathione peroxidase and superoxide dismutase. These results suggest that supplementation with B vitamins, iron, and vitamin C may be beneficial to patients with HCV, particularly those treated with pegylated interferon alfa and ribavirin. Additional research is warranted



ASLD Nov 2008
Serum B12 levels predict response to treatment with pegylated interferon and ribavirin in patients with chronic hepatitis C virus infection.

P. Rosenberg, K. Hagen, Gastroenterology and Hepatology, Karolinska University Hospital, Stockholm, SWEDEN;

BACKGROUND The current treatment regimen of hepatitis C infection (HCV) with pegylated interferon (pegIFN) and ribavirin (RVN) has greatly improved the outcome for patients, but still only about 50% are cured. The need for more effective treatment, as well as better tools to predict treatment outcome, is urgent. Cyanocobalamin (vitamin B12) is stored in hepatocytes, and essential in several biological processes. Studies have shown that B12 inhibits the translation of HCV RNA by interfering with the internal ribosome entry site. The clinical implication of B12 in the setting of antiviral treatment is unknown. AIM To evaluate the correlation between pretreatment B12 serum levels (s-B12) and end-of-treatment response (ETR) in patients with chronic HCV infection. METHODS 113 treatment naïve patients, undergoing treatment with peg-IFN α2a or 2b and RVN, at our clinic between the years 2000-2007 were identified. Serum samples were collected immediately before treatment start and stored at -70 degrees celcius awaiting analysis. S-B12 was analyzed according to routine methods. Baseline characteristics, including liver biopsy, and treatment response were collected from the medical records. Pre-treatment s-B12 levels were correlated to ETR using uni-variate analysis. The data was then further evaluated in a logistic regression model, including s-B12, genotype, viral load, fibrosis stage (Batts Ludwig), age, gender and any dose-reduction during treatment. RESULTS Of 113 patients, 99 (59 males and 40 females) completed treatment and had frozen baseline serum samples and medical records available. Mean s-B12 was 331 pmol/L in ETR and 260 pmol/L in non-responders (NR) (p=0.012). Median age at start of treatment was 49 years (range 27-81). In patients with s-B12 levels of ≤ 360 pmol/L, 23 (31.5%) were NR and 50 (68.5%) were ETR. In patients with s-B12 > 360 pmol/L, one (3.8%) was NR and 25 (96.2%) were ETR (p=0.0034). For further analysis, data on fibrosis stage and genotype was available in 89 patients. The results of the multi-variate analysis were as follows: Pre-treatment s-B12 > 360 pmol/L vs ≤ 360 pmol/L: OR 19.4 CI 1.8-208, p=0.013 Stage of fibrosis 3-4 vs 0-2: OR 0.26 CI 0.07-0.94, p=0.038 Genotype 2/3 vs 1/4/5: OR 10.1 CI 2.27-44.9, p=0.002 Dose reduction, age at treatment start and gender was not significantly correlated to ETR. CONCLUSIONS S-B12 > 360 pmol/L is significantly correlated to ETR in HCV patients treated with peg-IFN and RVN. This correlation is independent of previously known predictors of response. Our results suggest that B12 may be of importance for the suppression of viral replication during anti-viral treatment.


Matformin lowers Vit B12 and Folate

http://www.naturalnews.com/030234_Metformin_vitamin_B12.html

[CoWriter]

" I'm going to start saving a little stash for all that SamE we will need."

Be careful how youb store it.  I remember Dr Steier saying SAMe is very unstable and can be easily damaged by heat.

Co

[CoWriter]

Twice a day with food.

I myself would go with whatever is cheaper.  Sometimes the higher mg tablets turn out to be cheaper.

Co

[evangelin]

Thank you so much for that beautiful explanation.  I'm sure many of us really appreciate your taking the time to write it all out for us.  I know I do.  :>)  I'm going to start saving a little stash for all that SamE we will need.  
Eating more protein is making a big difference for Joe.  His cook had a hard time adjusting to this change but I'm coming around.  :>)  
Ev  

[jusjames]

why dont you just ask him bali ? you know where to find him

[Bali05]

How did CS take his SAMe,TMG, B-vits ect....

For example 1600mg SAMe , as an 4x daily 400mg , 2x 800mg or 1 x 1600mg ?
Also it can be irritating to the stomach so with food or without , does it matter ?
Same for TMG. 5x 1000 or 1 x 5000mg ?

[smaug48]

Thanks for that post, Co - please continue to drop in!

[willing]

thanks Co - nice summary. A positive message here is to not simply accept nonresponse as a given - particularly when not accompanied by poor IL28B status and all the more so when the viral genotype is favorable. There are lots of stories here of people who have overcome previous tx failures - with or without supplements.

Regarding the supplement choices, with a sample size of 1 and multiple effects it's impossible to figure out which factors were significant - a typical problem with assessing supplements. (Weight loss? better rbv?  SAMe? alinia? )  I personally hate taking pills so had to be dragged to this kicking and screaming but the data from a recent well-designed clinical trial is explicit enough to motivate me to take 1600mg SAMe with my other daily poisons (though I passed on the rest of the list).

http://www.ncbi.nlm.nih.gov/pubmed/20854821
Among nonresponders, a month of ifn with 1600mg SAMe yielded a doubling of the 2nd phase decline relative to a month without.   This was in G1s so even the improved decline of 0.27 log iu/ml/wk is pretty wimpy as an SVR predictor, eg
http://www.ncbi.nlm.nih.gov/pubmed/20738775
One can't expect miracles - but it  seems to have a measurable impact.  The decision to include  nearly all supplements seems primarily a subjective one since there's never adequate data. However at least for vit D and now for SAMe the preliminary  evidence seems  pretty good.

[merryBe]

good to see you again, Co-righter

I hope you'll be around when I start round 2...

intending PI, NTZ, Soc. metformin, and HR's stat GRAS.

I'm a little puzzled as to why you all settled on the extra B12 what with the high protein diet?? Usually high protein means adequate B12 assuming a normal GI tract.

anyway, maybe we could have some PM's and work it out if you have time???

[fretboard]

I've been taking amino acids for years and they make me feel alot better and even give me a little more energy.  I wonder if ppl notice a difference or get an energy boost from taking supplements too?.  I notice that gauf was taking the Whey protein powder and I was wondering if he added the Whey powder to get some energy or was it for other reasons.

[Bali05]

the list of supps above were researched by CS specifically for tx. and were copied from an earlier post when he was in the planning stages.
the dosages listed BID are not correct , he only took those once per day not twice.

There is a lot you can do to boost energy and it really depends on your individual
situation. I would first start and  look if you have any deficiencies before supplementing. Too much of anything can also put more of a burden on your
system.

[fretboard]

If you take these supplements without being on tx do you get a boost of energy similar to amino acids?  Which gives better energy, supplements or amino acids?   Anyone know?   thx

[RobertBeWell]

You also have to be careful there are no unfavorable interactions with anything else. That's quite a cocktail there. I have enough trouble remembering to take 6 pills a day and a shot once a week.

[gauf]

I also took Whey protein powder + Alinia+Coq10+ some other stuff I forgot about. Sheesh. Some combo of this got me to SVR after 2 failed tox though.