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"Natural Medicine may offer some hope & support in the treatment of this spreading epidemic"

The incidence of Hepatitis C (HCV) within the world communities grows daily. Even at this early stage, it appears that a considerable number people have been effected throughout the world. In Australia alone, it is estimated approximately 291,000 Australians have been exposed to hepatitis C virus and 217,000 are living with chronic hepatitis C..

This has immense health implications. The existing health system is already starting to fail its patients due to the unprecedented demands and lack of funding. Together with this, the current system does not serve the needs of those patients requiring longer term management. Especially those suffering from diseases that lay on the fringe of every day health issues. Even the use of strong pharmaceuticals by orthodox medicine has yet to yield a high level of success in the treatment of this disease.

Natural healthcare can therefore play an important role in the support & management of the disease and provide options to individuals that would otherwise not be available. Hopefully this article will give those suffering from HCV a broader insight into HCV so as to improve the quality of care so desperately required .

Hepatitis C (HCV) virus.

Generally speaking, viruses are the most basic form of living organism which have no purpose other than to propagate themselves while damaging the host they have invaded. They are made up of protein which is encased in an envelope of lipids.

By and large, most viruses cause damage to human cells in one of two ways. Firstly, damage to cells can occur by “Cytopathic" pathways. This is where viruses either invade cells directly or replicate in a way that damages their host thus destroying the cell structure and function. Secondly, damage can occur by what is referred to as "Immunopathic”. This is where viruses provoke an immune response which in turn destroys surrounding cells.

Until recently it was believed that HCV belonged to the cytopathic category and that damage was confined to the liver. However, recent research suggests otherwise and have found HCV to cause injury through immunopathic mechanisms thus impacting on other areas of the body. In particular the virus effects a category of white blood cells known as peripheral blood mononuclear cells (PBMC's). When this occurs, treatment becomes more difficult and symptoms more difficult to control.
 

HCV has also been found to be “indolent” in nature, meaning the virus is slow to. This phenomenon appears to be associated to a number of possibilities. Firstly, cellular reproduction of HCV can and is influenced by the longevity of the host cells therefore influencing reproduction processes. Secondly, HCV is genetically unstable therefore the reproduction process is predominantly faulty. HCV also tends to proliferated in to a variety of weak virus particles often referred to as “virions”. These HCV virons have different RNA structures and variations that over an extended period of time partially develop into more viable HCV RNA patterns thus spreading more vigorously as the disease progresses. This could explain why many infected individuals remain symptom free for such long periods of time after contracting the disease.

Despite the ongoing investigations, opinions are many on the absolute mechanism of indolence with others researchers suggesting that the slow rate of HCV reproduction is more likely to be influenced by the fact that the rate of infected cellular destruction by the immune system is predetermined by it's viability. In other words the rate at which infected cells are destroyed may virions replicate in sites beyond the reach of antibodies making it difficult for the phagocytic process to occur.

In comparison to other viruses, HCV is exceptionally tiny. It circulates in particularly low amounts and is extremely virulent. The virus is highly infectious and is easily passed on where there is an opportunity via blood-blood contact. HCV is also extremely resilient, making it difficult for the body to kill. It is classified as an RNA virus meaning that its genetic material is made up Ribo Nucleic Acid as opposed to DNA. It is therefore less genetically stable than the DNA viruses and prone to rapid mutation creating varieties of the HCV strain. The various types are distinguished by variations in their genetic map evolving into different strains which are largely, but not exclusively, associated to various regional parts of the world. HCV is also a fragile virus which mutates while present in individual patients. This results in a high degree of heterogeneity which is associated with greater resistance to drug therapy. The longer the persistence of the infection the more variations are likely to be present. This results in these quasi species presenting a more complex problem to the immune system.

Unlike hepatitis B, HCV is not a retrovirus. Retroviruses by their nature, invade the host cells as well as attempt to integrate their own genetic structure into that of the host cell. This of course, causes further disruption and has the effect of corrupting the healthy DNA and using the infected cells to further the proliferation process.

Symptoms of Hepatitis C.
 
The general symptomatology of HCV is not to dissimilar to that of "CFS" (ME) and where a case presents with CFS type symptoms that have not been investigated and who fall into a high risk category (eg.. IV drug users or health workers), differential diagnosis may be required. Generally speaking though, many infected individuals remain symptom free or will experience only a few of the symptoms discussed below that will come and go.

• Flu like illness with alternate with chills and fever.
• Pains in the liver region.
• Digestive and bowel disturbances (eg.. IBS, bloating, diarrhoea, etc)
• Joint and muscle pains.
• Night sweats.
• Depression, mood swings and mental fatigue.
• Cognitive dysfunction.
• Chronic fatigue and/ or sudden attacks of exhaustion.
• Adverse reactions to alcohol.
• Frequent urination especially at night.
• Loss of appetite.
• Digestive disturbances
• Frequent or continuous headaches.
• Sleep disturbances.
• Chest pain and palpitations.
• Pronounced fluid retention.
• Itchy skin.
• Blood sugar irregularities
• Dizziness and peripheral vision problems.
• Small red patterns of inflamed blood vessels known as "Spider Naevi".
• Irregular menses
• Severe premenstrual tension
• Lower libido.

Generally speaking, the majority of patients with chronic HCV experience fluctuations in their sense of wellbeing. This is sometimes reflected by the liver function tests, which often demonstrate a classic pattern of sharply fluctuating liver enzyme levels. However, these patterns do not necessarily correlate to the severity of symptoms, and they are far from being a conclusive indicator of liver damage.

Clinical Presentations and phases.

From a clinical perspective, the symptoms of HCV can be classified into two categories. Firstly, the disease can both hepatotrophic and lymphatotrophic thus causing progressive liver disease and chronic lymphatic disorders. The second category is caused by the disordered response by the immune system to the virus. This category is also divided into two general types, autoimmune type conditions which are bought about by the immune system attacking body tissue and the second type being various ME or CFS like syndromes which seem to affect a broader part of body function.

Generally speaking, very few people with HCV realise anything is wrong with them at or around the time they contract the disease. Unlike other forms of hepatits, less than 5% will suffering from the classic acute symptoms such as jaundice, diarrhoea and nausea. Even them the symptoms are mild.

As discussed, the majority of patients that contract HCV tend to experience symptoms associated to the chronic form of the disease. The rate at which infected patients go on to experience these symptoms may vary considerably. For example, some individuals develop serious problems within 5 years while others take up to 13 to 15 years. Age appears to have a large influence on the progression of the disease. Those who get infected later in life tend to deteriorate more rapidly than those infected in their youth. Those infected at a reasonably young age are more likely to develop liver disease such as cirrhosis and liver cancer as their life expectancy is much greater.

Interestingly, it is estimated that as many as 20% of those exposed to HCV may have the ability to clear the virus. Some individuals for example are antibody positive but PCR negative (Polymerase Chain Reaction test) and therefore not currently infected. This suggests that the Human Leucocyte Antigen (HLA) of patients determines the likelihood of their being able to mount a detectable T-cell mediated response to the virus. Not all patients with HLA type manage to do this and it seems that very few manage to have an immediate spontaneous response once they have become chronically infected.

In clinical terms, HCV infection usually begins to cause problems in the liver between 5 to 10 years after infection. It is thought that some patients may not develop anything more serious than mild liver disease throughout their lives, while a few patients progress to cirrhosis within 5 years. There is some anecdotal evidence to suggest that people who are infected in later life deteriorate much more rapidly.

Patients with chronic hepatitis are sometimes classified according to the degree and type of injury found in their livers. This is relatively easy to assess in cases of Hepatitis B, where liver function test results give reasonably accurate indications of liver function and histological health. However, with HCV these indicators unfortunately only give the practitioner a brief glimpse of the possible damage created by the virus. Together with this one could be experiencing little or no symptomatology in relationship to the damage caused by the disease. Often liver biopsy’s are recommend to accurately ascertain the true damage to the liver.

Mortality rate.

In reality the quality of information is not yet good enough to give accurate long term prognosis expectations of those suffering from HCV. Keeping this in mind, information currently available suggests that the mortality rate of HCV related liver failure is estimated to be around 5 to 10% and more likely 7%. However, it is important to note that this group often have poorer health than others and a higher viral load than the average. There are also a number of other variables which are thought to influence the long term prognosis which are difficult to measure. These include lifestyle factors such as diet, exercise, etc (which are difficult to factor in to the equation).

Cirrhosis

Cirrhosis of the liver also plays a large part in the long term prognosis of a patient and can lead to a variety of additional symptoms especially those associated to circulatory changes of the blood. These can include the development of varices (especially of the esophagus, which are indirectly caused by poor blood flow through the liver), Encephalopathy, where by patients may develop impaired mental function due to the liver not breaking down waste products in the blood as efficiently as it should or as an end result of the blood bypassing the liver. These events can eventually cause the liver to fail.

As mentioned, Cirrhosis can lead to a variety of problems because blood is unable to flow freely through the liver. The first symptom is ascites, which is a swelling of the abdomen due to a build up of fluid. This needs to be treated with a low salt diet, and possibly a diuretic to help the kidneys excrete more salt and water. The second problem is enlarged distended blood vessels around the stomach and gullet. They tend to develop due to blood trying to find its way around the scarred liver. When this occurs, blood vessels tend to bleed into the stomach and may require urgent treatment. The third problem, which is fortunately rare, is the development of liver cancer, (hepatocellular carcinoma. HCC).

There is also a possible pattern of differing natural history according to the sex of the patient. For example, women may be more susceptible to autoimmune phenomena, while men may experience more severe liver problems. This may be linked to menstruation in women and the level of iron in hepatocytes in males.

Liver cancer

In the case of HCV patients it is often said that about 5% of those with cirrhosis progress to HCC over the subsequent ten years. If this is the case then 1 % of HCV patients may be expected to develop HCC as against an average incidence of about 0.05% in Western countries. Thus HCV significantly increases the likelihood of developing HCC. It is important to stress that there is not yet enough data to provide exhaustive figures at stage.

Lymphatic Disease

Although HCV frequently infects the lymphatic system this is currently thought to cause few instances of serious illness. However enlarged lymph nodes in the liver are detectable in most chronic patients and many experience occasional sub clinical symptoms of lymphatic infections such as swollen glands.

Autoimmune Disease

A number of autoimmune diseases are linked to hepatitis C, although it should be stressed that apart from autoimmune thyroid disease, their occurrence is quite sporadic. It may affect perhaps 20% of patients at most during the course of the disease and generally effecting females only. They include such conditions as cryoglobulinemia, autoimmune thyroid disease, autoimmune hepatitis, membrane proliferative glomerulonephritis, polyarthritis, porphyria cutanea tarda,. Sjogrens syndrome etc which can affect virtually all organs.

It also seems that a large number of other diseases may be connected to HCV though they have not yet been scientifically linked. Such diseases as systemic lupus erythematosus occur suspiciously frequently in populations which are known to have high incidences of HCV. Despite all the evidence, the understanding of HCV and the development of autoimmune disease is still not fully understood.

HCV & Myalgic Encephalomyelitis (ME)

It is not uncommon for hepatitis C patients to have been previously diagnosed as having M. E. (CFS). This does not necessarily mean that they have been misdiagnosed since the two conditions are not mutually exclusive. It would appear a significant number of patients presenting with symptoms definitely qualify as candidates for chronic fatigue syndrome. Such symptoms as "problems with memory sequencing, spatial disorganisation, trouble giving and following directions, difficulty processing problems, slow intellectual speed, difficulty processing visual and auditory information, forgetfulness, irritability, mental confusion, inability to concentrate, impairment of speech and/or reasoning, light headedness, mental fogginess, word finding problems, distractibility, difficulty processing more than one thing at a time, inability to perform simple maths functions, problems with verbal recall, related motor problems, disturbances in abstract reasoning, sequencing problems, memory consolidation, short term memory distortions, fatigue, etc", are all common experiences of both groups of patients. Taking this into consideration and the fact that symptoms are commonly shared between the two groups it would be prudent to consider a differential diagnosis. Especially where the suffer is in what is considered to be in high risk life style situation. This would include IV drug users, health care workers, etc.

Depression

Another common symptom is depression. Researchers hypothesises that this may be linked to viraly induced disruption of serotonin production. Other researchers have also speculated that fatigue, depression and mental dysfunction associated to the condition, may be caused by poor cerebral blood circulation. HCV patients for example, undergoing interferon therapy and complaining of depression, have been shown to suffer from poor cerebral blood circulation. It is also generally accepted that depression is linked to poor sleep quality, a symptom reported by both groups of patients.

Transmission.

Generally speaking, HCV is transmitted via blood to blood contact. Its is known to survive in dried blood for longer periods than many other virus (eg. HIV). HCV is uncommonly small and often inhabits blood cells. The virus will remain intact as long as these cells remain in tact. Transmission is usually by the following mechanisms. For example, patients can be infected by via blood transfusions, operations and infected blood products. The majority of cases though, at least in western countries, are infected via intravenous drug use. This represents approximately 75% of all recorded cases.

Sexual transmission represents a small group of those infected with the available information suggesting a very low rate of sexual transmission regardless of the sex practiced.

Household contact may account for more cases than sexual transmission (2%). Because the virus is so difficult to kill and can be harbored in invisible films of blood the opportunities for it to jump to a new host within the home can be high. This may vary of course according to the practices of family members and may be linked to cultural factors. For example, the combination of bleeding gums and tooth brush sharing is a good candidate for transmission. The use of the same razor by more than one family member is another candidate for possible transmission.

Occupational transmission represents about 2% of those who have contracted HCV. Dentists who practice oral surgery and health workers who administer intravenous injections are at an increased risk. The percentage of mothers with HCV passing on the virus to their child appears to be very low. It is likely the point of transmission is via the birth process not via the womb.

Blood tests for hepatitis C.

Generally speaking, the discovery of HCV normally occurs through routine tests done on liver function (LFT'S). However they are not always good indicators of the health of the liver in HCV patients. Alanine aminotransferase (ALT) and aspartate aminotranferase (AST) are the two most common indicators used and when above normal range further investigation is instigated. ALT is thought to be a more accurate reflection of liver inflammation and health while AST indicators can sometimes be an unreliable as it can be produced by other organs such as the heart. Alkaline phosphatase is the test most often used to detect obstruction of the bilary system, though it can be associated to progressive liver disease.

Bilirubin, a bile pigment usually extracted from the blood by the liver can also indicate a decreased efficiency of the liver. Albumin, a major protein found in the blood generally corresponds to the livers effectiveness in forming protein. Low levels usually indicate problems with protein synthesis which can correspond to liver damage. Prothrombin time is a test which assesses the efficiency of blood clotting. When the liver is damaged it may fail to produce blood clotting factors.

Viral load testing also plays a big part in the detection of the disease. These include a variety of antibody detection and virus detection tests that indicate the presence or absence of HCV itself in the blood or other body tissue. These include such tests as the ELISA Ill (Enzyme liked Immunosorbent Assay) and the RIBA (Recombinant Immunoblot Assay III) which are used to confirm the presence of HCV antibodies. RIBA (Recombinant Immunoblot Assay III) is seen as a highly accurate test but still cannot be reliable to 100%. Because the RIBA Ill test is more expensive than ELISA it tends to be used as confirmatory tool.

The matrix test is another variation on the antibody test using a prodedure which uses a technique known as "in vitro enzyme dot blot immunoassay" and considered to be highly accurate. Unfortunately, it takes up to six months for antibodies to HCV to form in the blood. People seeking an early diagnosis after a suspected exposure should seek retesting after six months of the initial antibody test.

Virus detection and analysis tests try to assess the presence or absence of HCV itself . They are more definative than the antibody tests but usually more expensive to their sophisticated detecting minute traces of any organic substance in any given medium (in this case blood). In the case of HCV it works by taking a sample of blood from the patient being tested and amplifying the nucleic acid associated with the virus many millions of times. This brings the detectable levels up enabling experience technicians to assess how much of the original material is present in the sample. Although PCR has limitations, it is probably the most useful single test. The b-DNA test for HCV, which is sometimes referred to as Quantiplex tests, searches for the presence of the virus in the blood but is less sensitive than the PCR test. It generates an estimate of viral loads above a certain level.

Nutritional and dietary considerations.

Diet is an essential but controversial issued for HCV suffers. Dietary recommendations vary from one nutritional expert to the next and are handed out to patients with frequency resulting in a sense of confusion and despondency. More often than not, unhealthy diets rich in fats, carbohydrates and sugars are commonly consumed by newly diagnosed patients which only contribute to the over all sense of sickness. On the other hand, there is also a group of individuals who adopt extremely strict health diets prior to diagnosis, knowing that something is wrong but not being able to identify the problem.

From a perspective of the patient, Its important that each individual appreciate that chronic HCV is a dynamic condition associated with a number of varied clinical profiles. It would therefore be safe to say that there is no such thing as "Hepatitis C DieC. For example, a patient with normal liver enzymes and a good appetite will have very different requirements to one who is under weight and has advance cirrhosis of the liver.

Keeping this in mind, some basic nutritional understandings need to be considered. For example, protein plays a vital part in many metobolic functions in the body and therefore considered an important part of the diet. As the liver plays a unique role in protein metabolism any impairment of the liver may influence the production of such substances as albumin, prothrombin and transferrin. Therefore, cutting back on protein will result in insufficient building blocks being available to the liver for protein production and may over an extended period of time, as shown in experimental animal studies, lead to hepatitic necrosis and fibrosis.

The importance of adequate protein in the diet to proper immune function is also another consideration. For example, the most severe effects of protein malnutrition are on cell mediated immunity, although all facets of the immune function are ultimately effected.

The other side of the protein debate is the type of proteins to be considered. It is well understood by the experienced clinician that heavy red meat protein for example can labour a weakening digestive system. Typically HCV suffers experience many symptoms associated to this particular problem and purely from a point of view of comfort it may be best avoided. If protein digestion remains a problem after dietary intervention, Betain Hydrochloric Acid may have to be considered. Papain, an extract of papaya will also assist in the digestive process.

Supporting the reduction of red meat in the diet for HCV sufferer is the view that iron in too high a level can cause increased concentrations of sustainable iron deposits in liver cells. This is mainly due to fact that HCV suffers have a reduction in liver iron loss due to hepatic damage caused by the virus. Therefore, low levels of iron rich food decrease the possibility of hepatic build up which can lead to further complications.

Carbohydrates are another important issue to be addressed as they play an important role in the energy production process. Keeping this in mind, many individuals with HCV suffer from a range of symptoms associated to poor carbohydrate digestion and assimilation. To further complicate the issue there is generally an increase potential for gut dysbiosis and leaky gut syndrome. Generally speaking, these conditions are possibly due more towards lifestyle and eating habits than the disease it self. For example, bloating and abdominal discomfort are commonly experienced when refined carbohydrates and/or yeast containing foods are consumed, though not an uncommon experience when more complex carbohydrates are included as a part of the diet. This in turn often leads to further depress energy levels as well as increased feelings of depression. Reductions in symptoms can be reduced by modifying the intake of refined carbohydrates and yeast based foods such as breads, etc. Pancreatic enzyme supplements can be taken after each meal. In many cases this simple approach can have a positive impact on not only the symptomatology associated to gut dysfunction, but also on the energy levels of the sufferer. Gut dysbiosis should also be addressed with prebiotic and probiotic therapy combined with treatment protocols for gut repair.

As far as carbohydrate consumption is concern, there are also those who have trouble maintaining their body weight. A low carbohydrate diet could very well contribute to substantial weight loss and a reduction in available energy in these individuals. Underlying food intolerances will also contribute to poor nutritional uptake impacting on weight. The damaged liver also has to be considered as a contributing factor in maintaining weight as it plays such a vital role in energy metabolism. As as shown in numerous experimental studies for example, where there is chronic liver injury there is less glycogen stores in the liver. This in turn forces the body to use other energy sources therefore increasing the breakdown of protein and fats to provide energy which causes weight loss and in time muscle wasting.

Dietary fats are an important factor in the well being of those suffering from HCV. Saturated fats for example will often cause nausea and uncomfortable digestive responses. Even those who have asymptomatic responses to saturated fat consumption increase risk of developing fatty infiltration and or stasis of bile in the liver and gallbladder. High levels of saturated fats will also influence an already weakened digestive system and as well as cause long term abnormalities in liver function and health. Increased blood levels of cholesterol, free fatty acids, triglycerides and bile acids also inhibit various immune functions including the ability of lymphocytes proliferate and produce antibodies. The ability of neutrophils to migrate to areas of infection and engulf and destroy infectious organisms are also impaired. Alternatively when taken in moderation, oils containing eicosapentaenoic acids (EPA), linolenic and linoleic acid which are found predominantly in cold water fish, Flaxseed and Evening Primrose Oil do not cause liver abnormalities or have an adverse effect on the immune function and will contribute to the overall wellbeing of the individual.

Sodium consumption is another factor that needs to be taken into consideration. Sodium should be reduced in the diet of those suffering from HCV, especially where there is an abnormal accumulation of fluid retention in the abdomen (ascities). This commonly occurs in states of advance cirrhosis and should be taken seriously. Patients without ascites should not over indulge in table salt, although their restrictions may not be as severe.

Aflatoxins are also thought to be a co-factor in contributing to liver stress and damage. These substances are produced by fungi which grow on nuts stored in hot and humid conditions and it advised that patients with HCV avoid all nuts, especially peanuts.

Sugar

Sugar consumption, even in small amounts, can impair immune function. This appears to be due to the fact that glucose (blood sugar) and vitamin C compete for transport sites into the white blood cells. Decreased vitamin C levels due to excessive sugar consumption may result in a significant reduction in white blood cell function. This is based on evidence that vitamin C and glucose appear to have opposite effects on immune function and the fact that both require insulin for membrane transport into many tissues.

Studies have shown for example, the ingestion of 100 gram portions of carbohydrate as glucose, significantly reduced the ability of neutrophils to engulf and destroy bacteria. In contrast, the ingestion of 100 grams of starch had no effect. These effects started less than 30 minutes after ingestion and lasted from two to five hours. Typically there was at least a 50 per cent reduction in neutrophil activity two hours after ingestion. Since neutrophils constitute 60 -70 per cent of the total circulating white blood cells, impairment of their activity leads to depressed immunity.

In addition, ingestion of 75 grams of glucose has also been shown to depress lymphocyte activity. Other parameters of immune function are also undoubtedly affected by sugar consumption.

Alcohol

Alcohol is a potent toxin to the liver. Increasing evidence has shown that alcohol intaken by individuals suffering from HVC have an increased risk of cirrhosis of the liver. A combination of alcohol and HCV has been shown to accelerate the progression of the disease.

Iron

The liver plays an important role in the metabolism of iron and is the primary storage organ. The average daily diet contains approximately 10 to 20mg of iron daily with about 10% of this iron being eliminated from the body. Patients with Hepatitis C also have increased difficulty excreting iron and as a result, can be venerable to the possibility of hepatitic overload. As a consequence of this, iron overload can cause liver damage as well as increase the overall deterioration rate of the organ. Iron over load also reduces the response rate of the immune system in patients with Hepatitis C. Evidence suggest the iron over load may also contribute to the reduction in response rate of immune building therapy including the use of herbs.

Iron supplementation therefore should be avoided. Iron rich foods such red meat, liver, cereals fortified with iron reduced while iron and iron coated utensils replaced. Levels of organic iron found in dark green leaf plants such as spinach and parsley have been found not to contribute to iron overload.

Overweight

Being over weight can increase abnormalities related to the liver in individuals suffering from HCV. These include elevated ALT and AST readings (against those who are of normal weight with HCV), fatty deposits in the liver (steatosis), fatty inflammation and fatty cirrhosis. Studies suggest that over weight individuals with fatty liver related conditions and Hepatitis C who reduce weight have liver related abnormalities improve.

Summary

Diet obviously plays an important role in the long term management of HCV. Foods should be fresh, of good quality, and rich in vitamins and minerals. Include plenty of low fat proteins as well as suitable live yogurt cultures where no dairy sensitivity exists. Freshly squeezed vegetable and fruit juices can be taken daily and plenty of purified water consumed. Fried and highly heated oils should be avoided while oils such as oilve oil, flaxseed and omega 3 oils be included in the daily menu. Alcohol is to be avoided where possible coffee, table salt, nuts, especially peanuts, sugar, carbonated and glucose fortified drinks, chocolate, food additive and artificial colours.

Herbal, Vitamin and Mineral Considerations.

Herbs, vitamins and minerals play an important role in the management of HCV. They will in time have a positive impact on viral load and liver assays as well as the general health of the sufferer, especially where diligence is applied. While most people with HCV will require on going treatment this is not a reflect on the efficacy of the herb and nutrients but rather a reflection on the nature of the disease itself. Most sufferers at some stage will be addressing a range of symptoms and health difficulties with natural healthcare playing an important roll in treatment protocols during these various stages.

St Marys Thistle (Silybum marianum)

The biological activity of silymarin and silybin in particular has been the subject of numerous scientific studies. Early interest focused on the hepatoprotective activity of silymarin against liver damage caused by carbon tetrachloride (M4) and the Amanita mushroom poisons. Subsequently, the hepatoprotective action of silymarin was shown also to extend to ethanol and other types of poisoning. The principal mechanism underlying the hepatoprotective effects of milk thistle and silymarin is a protective effect on the cell membrane, mediated by a strong free radical scavenging and antioxidant action. Silymarin has been found to protect against ethanol- induced hepatic lipid peroxidation by increasing hepatic glutathione levels, as well as increasing superoxide dismutase (SOD) expression and activity in cells taken from patients with chronic liver disease. Silybin has been shown to increase the activity of both SOD and glutathione peroxidase in human erythrocytes.

Silybin can accelerate the regeneration of hepatocytes in damaged livers through activation of the DNA-dependent RNA polymerase, resulting in an increased rate of protein synthesis and mitosis. Silybin did not stimulate proliferation of fast growing cell lines (hepatoma cells, Hela and Burkitt lymphoma cell lines) in vitro, a finding that alleviates concern that milk thistle might stimulate the proliferation of malignancies.

Empirically, the herb is well documented. This is especially so in Europe (mainly Germany), where Silymarin concentrates have been used extensively by the medical profession for the treatment of liver disease and jaundice. Histological, clinical and laboratory findings in both human and animal studies, have shown silymarin to have a beneficial effect in the treatment of the following disorders. Alcohol and chemical induced fatty liver, Chronic viral hepatitis (of all types), Cirrhosis, Viral and chemical induced hepatic damage, and Jaundice. Based on the information provided by clinical research and studies to date, Silymarin marianum provides a safe alternative in the management and treatment of liver disease.

Dandelion Root. (Taraxacum officinale)

The common dandelion (root) is recognised by herbalists all over the world as an excellent liver remedy. It is rich in many nutrients, being particularly high in vitamins, minerals, protein, choline, inulin and pectin's. Studies in humans and laboratory animals have shown that dandelion enhances the flow of bile, improving such conditions as liver congestion, bile duct inflammation, hepatitis and jaundice. Together with this, the herb has a positive impact on digestion. This is due to the bitter aspect of the herb which stimulates taste buds in the mouth. Their stimulation leads to the release from the gut wall into the blood stream of gastrin. Some bitters have not only been found to stimulate appetite and digestion through this mechanism, but also stimulate the liver and bile flow. Dandelion's beneficial effects on such a wide variety of conditions is probably closely related to its ability to improve the functional capacity of the liver.

Dandelion has also been found to stimulate the elimination of bile from the liver. This is a very important property in that if bile is not being eliminated from the liver, the liver is at increased risk of damage. Clearing of bile from the liver is very important in the treatment Hepatitis and other liver diseases since it assists the decongestion of the liver. The primary therapeutic actions of dandelion are due to the bitter principle taraxacin and inujin (bitter glycosides). Other constituents include resin, levulin, pectin, taraxanthin, sesquiterpenes, fatty acids, flavonoids, vitamins and mineral salts.

Astragalus. (Astragalus membranaceus)

Astragalus is a highly valued Chinese herbal tonic. Like Ginseng, its pharmacological properties are varied including immuno- potentiating effects, anti-bacterial and anti-viral properties, the ability to promote nucleic acid synthesis in the liver and spleen, hepatoprotective, anti- inflammatory activity, cardiovascular tonic effects such as hypotensive and vasodilatory action as well as a possible blood glucose balancing action. The herb has also been found to increase superoxide dismutase activity thus acting as a powerful anti-oxidant as well as promoting cartilage growth in vitro.

Experiments also show astragalus to be liver cell protective in laboratory induced hepatitis by preventing liver glycogen reduction caused by carbon tetrachloride exposure. In conjunction with Silybum marianum (St Marys Thistle), it would appear that astragalus, with its anti-viral and liver protective action, may contribute many benefits in the treatment of Hepatitis C. Together with the above actions, other research has found that the herb to be very useful in the treatment of kidney disease having the ability to reduce urinary protein in chronic and acute nephritis. These effects appear to be mainly due to the saponins and polysaccharides found in the herb.

Whole root extracts have also been shown to have a profound effect on phagocytic and macrophage activity. In a variety of studies involving mice, Astragalus was shown to enhance phagocytic activity and increase super-oxide production and acid phosphatase activity of peritoneal macrophages. These benefits appear to also be passed onto the humoral immunity. Oral doses of the dried extract when given to humans were shown to increase levels of anti- bodies such as lgE and lgM. In another study, two months of oral treatment in subjects susceptible to the common cold, greatly increased levels of lgA and IgG in nasal secretions. Oral doses of Astragalus were also found to increase serum levels of IgG as well as conversion percentage of lymphocytes when given to mice.

The herb has also been observed to exert a marked antiviral action. This is most likely to be due to increased immunity and possibly the enhancement of interferon production. Together with this observation, numerous studies have shown protective effects of Astragalus with both parainfluenza virus type 1 and Coxsackie B virus infection of myocardial cells in vitro and vivo after injection. In vitro, studies have also confirmed that the herb has anti-microbial effects against Shingella dysenteriae, Streptococcus haemolyticus, Diploccus pneumonia and Staphylococcus aureus.

Cordyceps

Historically, Cordyceps has been used to soothe the lungs, replenish the kidney, arrest bleeding and resolve phlegm. According to Traditional Chinese Medicine philosophy, the effect of cordyceps runs through the lung and the kidney meridians. It is said to have a positive impact on deficiency syndromes of the lung, phthisical (tuberculosis) cough and haemoptysis (cough containing blood), deficiency of yang (vital function) of the kidney as well as seminal emission and premature ejaculation. Cordyceps is also said to promote vital energy which can be given to patients recovering from weakness caused by severe illness and persons of advanced age. Cordyceps is well known for its effect in strengthening the body and restoring energy.

Cordyceps has also been employed as a tonic for strengthening the testes and ovaries acting as an aid in fertility . Nocturnal emissions have been also treated with the herb. Other actions attributed to cordyceps are homeostatic, laxative (especially in chronic constipation), and as a sedative and support for the adrenal glands.

More modern interpretations centre around the herb's effects on the respiratory system (specifically the lungs), the kidneys, immune system, liver and the glandular system.

Since the 1980's, pharmacologists have succeeded in defining the herbs constituents into several unique substances. These include such constituents as Coryceps essence, Cordyceps acid, glycocordy cepiglycan, cordycepin, glutamic acid, phenylalanine, proline, histadine, valine, oxyvaline, arginine, alanine, adenosine, d-mannitol and vitamin B12. Some of the substances have been found to improve the immune function within the human body and reinforce the resistance to various pathogenic bacteria and tumors. Studies have also attributed the herb to other pharmacological actions with effects being observed on the body including the nervous, respiratory, immune, cardiovascular, glandular systems and the liver.

In one particular study for example, patients with liver cirrhosis were given a combination of cordyceps and peach seeds (prunus persica). Following treatment with the herbal combination, low immune cell functions in the cirrhosis patients were improved with Helper T-cells, suppressor-T cells, Natural Killer cell (NK) function, and serum levels of complement returning to normal. Researchers concluded that the herbal treatment may be useful in preventing cellular decay of the liver an issue which is of great importance to those suffering from HCV.

Research studies have als shown that Cordyceps stimulates the growth of such active cells as T-cell, NK cell, mononuclear macrophagocyte as well enhance the secretion of various lymphokines. The immune system compounds in cordyceps responsible for this action are the polysaccharides. With the impact of Cordyceps on the body, it appears from a variety of studies that the vitality of NK-cells can be increased and the phagocytosis percentage of the mononuclear macrophagocyte can be raised. The herb has also been found to stimulate an increase in immunoglobulins G and M along.

Cordyceps has also been shown to help lower high serum cholesterol levels which commonly occurs in those suffering from HCV. In a large, well controlled clinical trial in China, researchers found that cordyceps caused a significant lowing of cholesterol (LIDIL, total cholesterol and total tryglycerides). It was also observed that all the patients in the trial had a significant elevation of high density lipoprotein (HIDIL). The patients received 330rng of cordyceps three times daily for sixty days.

Bupleurum falcatum.

Bupleurum root is an important component of a variety of TCM formulations particularly in remedies for inflammatory conditions. The main active ingredient of Bupleurum are steroidal-like compounds known as saikosaponins. These compounds have diverse pharmacological activity including significant anti-inflammatory action. Bupleurum saikosaponins have other therapeutic activities which include lowering cholesterol levels, preventing liver damage, improving liver functions in chronic hepatitis and mild sedativelpain relieving action on the central nervous system.

The anti-inflammatory activity of the saikosaponins seems to be related to an increase in the release of glucocorticoid hormones by the adrenal gland. This release of glucocorticoids by the adrenal gland is stimulated by the pituitary hormone adrenocorticotropic hormone (ACTH). Bupleurum thus increases the release of glucocorticoids by increasing the pituitary release of ACTH in turn increasing the functional ability of the adrenal cortex.

Over recent years scientific interest has grown sustantially in the possible use of Bulpeurum in the management of viral induced liver disease. A number of clinical trials using Bupleurum in chronic active hepatitis using oral doses of saikosaponins at a low dose showed reductions of serum liver enzymes over a period of time. This resulted in statistically significant changes at 3, 6 and 12 months. Other studies showed satisfactory results both in acute hepatitis and chronic hepatitis with good clinical results reported.

Chinese or Korean Ginseng (Panax Ginseng).

Perhaps the most famous medicinal plant in Chinese Medicine is Panax Ginseng the herb has been traditionally used to restore and tonify the "yang" or warmth quality within the body. It is a sweet, slightly bitter and warm herb, replenishing the vital energy of the body and increasing the production of body fluids. It has been used for centuries as a tonic for it's revitalising properties, especially after long illness.

Classified as an adaptogen by Western Herbal standards, the term denotes a common quality of many herbal remedies. It is this adaptogenic effect of ginseng that gives the herb it's reputation, realising it's potential as a general tonic, especially in debilitated and feeble individuals.

Ginseng posses immuno stimulating activity, as evidenced by its ability to enhance antibody response, cell mediated immunity, natural killer cell activity, the production of interferon, and lymphocyte and reticulendothelial system proliferate and phagocytic viability. Studies using Ginseng have also found the herb prevented viral infections in animals, presumably due to the combination of its immuno stimulating effects. Together with this, enhancement of cellular proliferation and function was shown on a variety of cell types including epithelial, hepatic, lymphocyte, fibroblast, thymic and neural cells.

Research studies an animals have confirmed the possible use of Ginseng in the treatment of hepatic disease. The studies are promising but have yet to be confirmed by clinical trials. To date, scientists have found Ginseng affects the liver in several ways. Firstly, ginseng enhances the activity of the livers specialised macrophages known as Kupffer cells. Secondly, it has being shown that the herb enhances hepatic protein synthesis which would be extremely beneficial for the elderly where this synthesis process is often reduced. Finally, Ginseng has also been shown to reverse diet-induced fatty liver as well as possessing significant protection to the liver against damage to chemicals. The clinical implications for the use of the herb in the treatment of hepatic disease are quite broad and support its use as a general tonic.

Pharmacologically speaking, ginseng is classified as an adaptogen, enhancing the ability of the body to cope with various stressors, both physical and mental. It's complex chemistry appears to act mainly on the hypothalamus, resulting in a sparing action on the adrenal cortex which is believed to be mediated through the anterior pituitary and Adrenocorticotropic Hormone (ACTH) release. This action, thus regulates the adrenal cortex response, so that the first phase of the body's non-specific response to stress is more efficient. This means that the response is stronger and quicker with the feedback control mechanism being more effective. As a result, glucocorticoid steroid levels return more rapidly back to normal as the stress decreases. During more prolonged stress or adrenal demand, it has been found that glucocorticoid production is reduced by the herb, while at the time increasing adrenal capacity. Numerous studies over the last forty years have confirmed the herbs use as a medicinal agent for the treatment of fatigue, enhancement of mental performance and general well being.

Slippery Elm. (Ulmus rubra, U. fulva)

Mild to moderate inflammatory bowel complaints are common among those suffering from HCV. Slippery elm will often provide relief from uncomfortable abdominal discomfort and pain, soothing the irritated gastrointestinal mucosa of the stomach and small intestines. The herb is classically referred to as a demulcent having additional nutrient qualities. It has an affinity with most gut complaints and an affinity for the mucous membrane of the gastrointestinal tract. The key action of the herb is its mucilage action on the surface with which it comes in direct contact where the herb produces a coating of slime, so to speak, that acts to sooth and protect exposed surfaces.

This explains why the herb historically has a long use in gastrointestinal inflammations, lesions and ulcers. Slippery elm has also been found to reduce the irritant symptoms associated to excessive stomach acids or digestive juice secretions. Slippery elm powder, for example, is a very popular remedy for relieving the effects of acid dyspepsia or gastric reflux after a heavy meal.

From an active constituent point of view, slippery elm has no real pharmacological action in the body and is used mainly for its mucilage effects. Research into the herb has found a variety of constituents in low levels which include galactose, 3-methyl galactose, rhamose and glacturonic acid residues.

Vitamin A

Vitamin A should be used carefully as excessive use of the supplementation can exert a toxic effect and cause damage to the liver. Doses over 2,500 daily should be avoided.

Vitamin B Complex.

The B complex group of vitamins are involved in hundreds of biochemical functions and reactions in the body. Where the diet is poor or deficient, vitamin B deficiencies become obvious and include tiredness, irritability, nervousness, and depression. A poor appetite, insomnia, anemia, constipation or high cholesterol can also be indicators of vitamin B deficiency. They are an active group of vitamins in that they provide the body with energy, basically by converting carbohydrates into glucose. They are also vital in the metabolism of fats and protein and necessary for the normal function of the nervous system. They are essential for the maintenance of muscle tone in the gastrointestinal tract and for the health of the skin, hair, eyes, mouth and liver. For example , vitamin B complex is important for the liver, in that it supports the cytochrome P450 system, which governs the liver's detoxification process. Vitamin B12 has also been found to be important to hepatitis suffers in that even when serum levels of B12 are normal the diseased liver of these individuals is unable to absorb the vitamin normally from the serum.

The requirements for vitamin B complex vary from one individual to the next. For individuals with chronic illness such as those suffering from hepatitis C, high dose B complex can be useful for improving general health, energy, and stamina. High doses of oral vitamin B complex in some individuals may cause nausea or headaches. In these cases low dose vitamin B therapy may be tolerated.

Vitamin C

Vitamin C functions biochemically as an antioxidant. It is required for the hydroxylation of proline to hydroxyprolione which is a step in the synthesis of collagen, the protein of connective tissue and intracellular cementing substances. Collagen is important in maintaining the health of bones, teeth, gums, cartilage, capillaries, connective tissue and the healing of wounds and fractures. Vitamin C is also required for the synthesis of serotonin, noradrenaline and certain steroid hormones. It promotes the absorption of iron, maintaining the immune system and the normalisation of cholesterol.

Vitamin C has a long history in the treatment of viruses. Biological studies have confirmed that the concentrate of ascorbate in leukocytes is one of the highest known in the body and is considered to be second only to that found in the adrenals. These high concentrations within the leukocytes are rapidly depleted by acute disease, infection and trauma, which indicate a high requirement for the vitamin during a disease state.

In clinical studies, large doses of vitamin C (40 to 1 0Ograms orally or intravenous) were found to improve acute viral hepatitis substantially within two to four days, while clearing the symptoms of jaundice within six days. Other studies found similar results, though one particular controlled study failed to confirm and validate similar effects claimed of vitamin C. However, Linus Pauling and colleagues claimed that systematic errors invalidated this study. In another controlled study, the researchers found that 2 grams or more of vitamin C per day appeared to increase resistance in hospitalised patients to hepatitis B. While 7% of the control patients developed hepatitis, none of the treated patients did.

From the perspective of chronic liver disease, patients with cirrhosis of the liver and Hepatitis C have an increased potential for the development of high concentrations of sustainable iron deposits in liver cells. This in turn can contribute to a rapid depletion in health and the long term survival rate of individuals with the disease, especially those who are experiencing cirrhosis of the liver. As high doses of vitamin C taken for long periods of time increases the potential for iron uptake it is recommended that doses above 500 mg daily not be taken unless for the management of acute symptoms.

Vitamin E

Vitamin E, also known as tocopherol is a powerful anti oxidant. It is particularly useful in combating fatigue, as well as supporting the immune system. Together with this it is thought to boost cell mediated immunity . Vitamin E deficiency is also been found to be linked to cirrhosis of the liver and poor metabolism of fats. It works closely with selenium to assist in some of the bodies metabolic actions.

Its capacity to reduce oxidative stress in patients with HCV has attracted the attention of researchers. There appears to be clear evidence that vitamin E prevents molecular changes which are associated to with the development of cirrhosis of the liver. Together with this, the research has been providing insights into the molecular mechanisms of fibrogenesis as well as the potential therapeutic approaches for patients with chronic hepatitis C

Lactobacillus Acidophilus

The microflora of the gastrointestinal tract has been described as a complex ecosystem consisting of anaerobic and aerobic micro-organisms. When gastrointestinal dysbiosis occurs in individuals with HCV, a variety of gut disturbances can dominate the health of the individual. These symptoms of course are generally not associated to the disease itself, but certainly a by product of the overall ill health of the individuals concerned. Re-establishment of proper bowel micro flora, especially using Lactobacillus acidophilus, therefore becomes crucial.

Probiotics of this type, work by adhering to specific receptors on the mucosal cells of the small and large intestine. As a result they tend to suppress the attachment of other bacteria that causes gastrointestinal imbalance. They also inhibit the proliferation of less beneficial bacteria by creating an acid environment through the production of acetic, formic and lactic acids. In hepatic encephalopathy, the administration of lactobacillus alter bacterial flora by lowering the number of gram-negative rods which produce ammonia and amines.

Other beneficial effects of probiotics include improving the production of factors which have anti- tumour activity, the inhabiting of cholesterol production, the suppression of toxin production by putrefactive bacteria in the intestine, the reduction of beta-glucosidase and other enzyme activity, and the production of natural antibiotics which are active against a wide variety of gram- positive and gram -negative organisms. Lactobacillus acidophilus has also been shown to inhibit the formation of germtubes by candida albicans which in turn contributes to minimise the invasive action of candida of the throat, intestine and vaginal epithelium.
 

Probiotics worth considering to support the immune system and gut balance include Lactobacillus acidophilus NCFM, Bifidobacterium lactis HN019 and Lactobacillus rhamnosus HN001.


Other Beneficial Supplementation.

Bifidobacterium Longum

Bifidobacterium longum is an inhabitant of the large intestine. It aids in the production of B-complex vitamins as well as provide nutrients for liver health. Bifidobacterium is involved in the inhibition of invading opportunistic microorganisms such as bacteria and yeast, deterring their reproduction and colonisation. It competes for both nutrients and receptor sites along the large bowel wall preventing pathogenic invasions. Together with this, bifidobacteria produce acids that lower the pH resulting in an increase in acidity in the region. Low pH balances impact on the capacity of harmful bacteria to proliferate as they prefer a more alkaline environment. This in turn effects the number of undesirable bacteria proliferating resulting in a reduction in the conversion of nitrates which are normally found in food being converted to carcinogenic nitrites in gastrointestinal tract.

Choline

Choline is considered to be one of the B-complex vitamins. It functions with inositol as a basic constituent of lecithin. The richest source of choline is lecithin. Choline appears to be associated primarily with the utilization of fats and cholesterol in the body. It prevents fats from accumulating in the liver and facilitates the movement of fats into the cells. Choline combines with fatty acids and phosphoric acid within the liver to form lecithin and is essential for the health of the liver and kidneys. Choline is also essential for the health of the myelin sheaths of the nerves and therefore plays an important role in the transmission of the nerve impulses. It also helps to regulate and improve liver and gallbladder function thus assisting in the prevention of gallstones.

Folic Acid.

Folic acid functions as a coenzyme with vitamins B12 and vitamin C in the breakdown and utilization of proteins. Folic acid performs its basic role as a carbon carrier in the formation of heme, the iron containing protein found in hemoglobin which necessary for the formation of red blood cells. It also is needed for the formation of nucleic acid, which is essential for the processes of growth and reproduction of all body cells. Folic acid is necessary for proper brain function, being concentrated in the spinal and extracellular fluids being essential for mental and emotional health. It also increases the appetite and stimulates the production of hydrochloric acid. In addition, it aids in performance of the liver.

Inositol

Inositol is closely associated with choline and biotin. Like choline, Inositol is found in high concentrations in lecithin. Vitamins B6, folic acid, pantothenic acid, and PABA also have a close working association with inositol. Inositol is effective in promoting the body's production of lecithin. Fats are moved from the liver to the cells with the aid of lecithin; therefore inositol aids in the metabolism of fats and helps reduce blood cholesterol. In combination with choline, it prevents the fatty hardening of arteries and protects the liver, kidneys, and heart. Large quantities of inositol are found in the spinal cord nerves and in the brain and cerebral spinal fluid and needed for the growth and survival of cells in bone marrow, eye membranes, and the intestines.

Magnesium

As discussed, digestion is often poor amongst those who suffer from HCV and as result magnesium levels may be depressed. Magnesium is an essential mineral that is involved in many essential metabolic processess. Primarily, most magnesium is found inside the cell where it activates enzymes necessary for the metabolism of carbohydrates and amino acids. By countering the stimulative effect of calcium, magnesium plays an important role in neuromuscular contractions. It also helps regulate the acid-alkaline balance in the body. Magnesium helps promote absorption and metabolism of other minerals, such as calcium, phosphorus, sodium, and potassium. It also helps the body utilize vitamin B complex, vitamins C and E in the body. It aids during bone growth and is necessary for proper functioning of the nerves and muscles, including those of the heart. Sufficient amounts of magnesium are needed in the conversion of blood sugar into energy.

Magnesium deficiency can occur in patients with diabetes, pancreatitis, chronic alcoholism, cirrhosis of the liver, arteriosclerosis, kidney malfunction, a high-carbohydrate diet, or severe malabsorption. Symptoms of magnesium deficiency may include apprehensiveness, muscle twitch, tremors, confusion, irregular heart rhythm, depression, irritability, and disorientation.

Zinc

Zinc is one of the most important minerals for the immune system as it is involved in so many immune mechanisms. These include both cell-mediated and anti body-mediated immunity, thymus gland function and thymus hormone action. When zinc levels are low the number of T cells through out the body is reduced, thymic hormone levels are lower and many white blood functions critical to the immune response are severely lacking. All of these effects are reversible upon adequate zinc administration and absorption.

Chlorella, Spirulina and Dunaliella salina.

These are excellent sources of numerous micro nutrients rich in vitamins, minerals, amino and fatty acids. They contains a range of substances that are thought to be good for the immune system, blood and the liver, as well as being partially rich in detoxification agents. It may be particularly useful to vegetarians as they contains such nutrients as B12 which may deficient in their diet.

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