FAQ Page Five
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V.1.0 What Should I Do About Nutrition? V.1.1 Foods to Avoid V.2.0 Nutrition and Cirrhosis V.3.0 Coffee, Tea, Caffeine and Other Stimulants V.4.0 Salt
VI.1.0 Alcohol VI.2.0 Tobacco VI.3.0 Marijuana VI.3.1 Cocaine VI.4.0 What are the Effects of Recreational Drugs? VI.4.1 Intravenous Drug Use Precautions VI.4.2 Cleaning Fits VI.4.3 Methadone
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V.1.0 WHAT SHOULD I DO ABOUT NUTRITION? Many dieticians and medical experts working with hepatitis C feel that except for alcohol, diet has little direct effect on the activity of the virus and the outcome of long-term infection. There is no specific dietary approach that can be recommended which can guarantee to alter the outcome of any particular liver disease. This isn’t to say that modifying your diet has no effect. Nutrition and the liver are interrelated in many ways. Everything we eat, breathe and absorb through our skin must be refined and detoxified by the liver, special attention to nutrition and diet can help keep the liver healthy. 85-90% of the blood that leaves the stomach and intestines caries important nutrients to the liver where they are converted into substances the body can use. Bitter foods are useful as they stimulate the digestive process and assist the liver. Eating salads containing bitter leaves such as dandelion or chicory 10-15 minutes before meals is a long-standing European recipe to aid the liver. In Taiwan, a diet high in vegetables was associated with a lowered risk of liver cancer in people with hepatitis C. Vegetable juices have a particular nature that helps lessen the bloated and stagnant feelings often associated with liver conditions. Vegetable juices act to flush out the body and relieve some of the symptoms that people with liver disease experience, such as heaviness and lethargy. The juice of carrots, beets, cucumber, spinach, celery , wheat grass and parsley are all used in liver cleansing fasts, and are generally thought to be good for livers. Drinking 2-3 liters of water each day is universally recommended for good health, but also protects against lymphatic congestion, which would put further strain on the liver. As for diets in particular, The Alternative Medicine Guide says: Jonathan Wright, M.D. recommends a diet low in protein to minimize stress on the liver. Whole foods diet that follows a hypoglycemic regime, of small meals throughout the day, avoiding stressor foods such as refined sugars, alcohol, and caffeine. Consume plenty of filtered water. Drinking fresh lemon juice water every morning and evening followed by vegetable juice is one of the most therapeutic regimes for the liver. Do this consistently for two to four weeks and then several mornings a week for several months and whenever liver symptoms reoccur. Have lots of vegetables each day. Ideal is at least one salad and one meal of steamed or lightly sautéed vegetables per day. Grains that are easily digestible, such as millet, buckwheat, and quinoa are very good. According to the Encyclopedia of Natural Medicine: A natural diet, low in natural and synthetically saturated fats, simple carbohydrates (sugar, white flour, fruit juice, honey, etc), oxidized fatty acids (fried oils) and animal fat, and high in fiber is recommended. And this from the Canadian Journal of Health and Nutrition: “Natural substances to help your liver detoxify are as close as your kitchen cupboard. Eating foods rich in lecithin (soybean), essential fatty acids (salmon, flax oil) and green leafy vegetables rich in fiber and antioxidants like vitamins C and E, are all gourmet cuisine for your liver. Lowering your intake of saturated fats, refined carbohydrates and animal protein and avoiding excessive amounts of alcohol are other recommendations that are good both for your liver and overall body health. Dandelion root and artichoke are both excellent spring time dietary condiments that are very helpful in improving liver bile flow. In addition to these food choices, supplements like L-methionine are an excellent choice for a congested liver. This sulfur-containing amino acid not only improves bile flow but also helps protect liver glutathione. Glutathione peroxidase is one of the body’s major detoxification enzymes and is in part defended by methionine during a toxic challenge to the liver...” The article goes on to describe the function of Milk Thistle. It concludes that the most potent substances for protecting the liver are Milk Thistle, Dandelion and L-methionine. L-methionine is classed as a “supplement,” and Milk Thistle and Dandelion as “botanical medicines.” - “Protecting and Enhancing Liver Function,” by Ronald G. Reichert, ND, Alive: Canadian Journal of Health and Nutrition (#161, March 1996): pp. 14-16. --- V.1.1 FOODS TO AVOID: PEANUTS: Some peanuts contain aflatoxins, a mold which increases the chance of liver cancer. RAW SHELLFISH: Vibro vulnificus, a bacteria, can be contracted by eating raw oysters, etc. Shellfish, if uncooked, can be very dangerous for people with liver disease. Either avoid or be careful that the shellfish you eat is well-cooked. SATURATED FATS: It’s generally best to keep fats at a minimum. Many people complain of increased pain in the liver area after eating high fat meals. With saturated fats, the liver must work harder than normal to neutralize their harmful effects. --- V.2.0 NUTRITION AND CIRRHOSIS Many chronic liver diseases are associated with malnutrition. One of the most common of these is cirrhosis. Cirrhosis refers to the replacement of damaged liver cells by fibrous scar tissue which disrupts the liver’s important functions. Cirrhosis occurs as a result of excessive alcohol intake (most common), common viral hepatitis, obstruction of the bile ducts, and exposure to certain drugs or toxic substances. People with cirrhosis often experience loss of appetite, nausea, vomiting and weight loss, giving them an emaciated appearance. Diet alone does not contribute to the development of this liver disease. People who are well nourished, for example, but drink large amounts of alcohol, are also susceptible to alcoholic disease. Adults with cirrhosis require a balanced diet rich in protein, providing 2,000 to 3,000 calories a day to allow the liver cells to regenerate. However, too much protein will result in an increased amount of ammonia in the blood; too little protein can reduce healing of the liver. Doctors must carefully prescribe the correct amount of protein for a person with cirrhosis. In addition, the physician can use two medications (lactulose and neomycin) to control blood ammonia levels. Persons with cirrhosis often experience an uncomfortable buildup of fluid in the abdomen (ascites) or a swelling of the feet, legs, or back (edema). Both conditions are a result of portal hypertension (increased pressure in the veins entering the liver). Since sodium (salt) encourages the body to retain water, patients with fluid retention can cut their sodium intake by avoiding such foods as canned soups and vegetables, cold cuts, dairy products, and condiments like mayonnaise and ketchup. In fact, most prepared foods contain liberal amounts of sodium, while fresh foods contain almost no sodium at all. The best-tasting salt substitute is lemon juice. In general, reducing meat protein, which is the most toxic protein to the brain, and substituting vegetable protein is advised when cirrhosis is present. --- V.3.0 COFFEE, TEA, CAFFEINE AND OTHER STIMULANTS In the book Healthy Healing by Linda Rector-Paige, N.D., PhD, she says: “...Some of the health problems of caffeine are...well known—headaches and migraines, irritability, stomach and digestive problems, anxiety, and high blood pressure. As an addictive stimulant, it works as a drug, causing jumpiness and nerves, heart disease, heart palpitations. Caffeine in excessive amounts, can produce oxalic acid in the system, causing a host of problems waiting to become diseases. It can lodge in the liver, restricting proper function, and constrict arterial blood flow. It leaches out B vitamins from the body...It depletes some essential minerals, including calcium and potassium...however the carcinogenic effects often blamed on caffeine are now thought to be caused by the roasting process used in making coffee, tea and chocolate. Since decaffeinated coffee has been implicated in some forms of organ cancer, conclusions are being drawn that caffeine is not the culprit—the roasted hydro-carbons are...” Unfiltered coffee raises serum cholesterol and liver enzymes. One study in the British Medical Journal shows that cafetiere (brewed, unfiltered) coffee raises serum LDL cholesterol levels and serum concentrations of alanine aminotransferase (ALT). Cafetiere coffee is made by pouring boiling water over ground coffee in a container with a sieve plunger. Dr. Rob Urgert and others at Wageningen Agricultural University in the Netherlands observed that unfiltered coffee raised alanine aminotransferase 80% above baseline levels relative to filtered coffee. Once the subjects stopped drinking cafetiere coffee, the liver enzyme and LDL cholesterol concentrations returned to baseline levels. The Dutch investigators write that “Daily consumption of five to six cups of strong cafetiere coffee affects the integrity of liver cells...” and they attribute the increases in cholesterol and alanine aminotransferase concentrations to the diterpenes cafestol and kahweol that are abundant in cafetiere. - BMJ 1996;313:00-00. --- V.4.0 SALT Those who are prone to episodes of ascites should try to maintain a very low sodium diet (less than 3 gr/day - I shoot for 1-2gr/day). --- VI.1.0 ALCOHOL There is no question that alcohol should be off limits for those with HCV. Studies have shown that patients who drink have a higher incidence of cirrhosis. But not only that, patients who drink also have a faster rate of progression to cirrhosis and higher mortality rates. As well, because alcohol interferes with the effect of interferon, those with a history of drinking problems may be denied treatment. EFFECT OF ALCOHOL ON HCV REPLICATION: A critical question is whether or not alcohol and hepatitis C infection are synergistic in a combined liver injury. In some patients, there are both histologic features of alcoholic liver injury and chronic viral hepatitis, but in most studies the predominant pattern is chronic hepatitis. Alcohol may enhance the replication of hepatitis C and produce a more severe injury independent of the direct alcohol-induced toxic injury. There is a correlation between HCV RNA levels and amount of alcohol consumed. Alcoholic patients with HCV infection have higher hepatic iron concentrations, which may be germane to increased HCV replication. Clinical evidence of hepatic activity and viral levels is significantly greater in those consuming greater than 10g of alcohol per day. EFFECT OF ALCOHOL ON PROGRESSION OF CHRONIC VIRAL C HEPATITIS TO CIRRHOSIS AND HEPATOCELLULAR CARCINOMA : There is a more rapid development of cirrhosis and hepatocellular carcinoma in the alcoholic with chronic HCV infection. The period from transfusion to the diagnosis of cirrhosis is shorter in the heavy drinker. As well, recent studies demonstrate that alcohol consumption in cirrhotics can lead to increased bacterial infection (American Journal of Gastroenterology, Editorial, May 2000, Volume 95, Number 5, Pages 1124-1125).
The risk for the development of hepatocellular carcinoma in alcoholic cirrhotics is 8.3 times higher in the HCV(+) patients than HCV(-) patients, and the prevalence of anti-HCV among alcoholics with HCC is 50-70 percent. Therefore, alcohol may modify the replication of HCV as well as the oncogenicity of HCV in hepatocellular carcinoma. INTERFERON THERAPY IN ALCOHOLIC PATIENTS WITH CHRONIC HEPATITIS C : Among alcoholic patients with chronic hepatitis C who remained abstinent during therapy with interferon, there was a significantly lower rate of HCV RNA clearance in those who consumed 70g/day of ethanol as compared to 70g/day up to the time of interferon therapy. - “Hepatitis C and Alcohol,” by E.R. Schiff, abstract submitted by the author to the National Institute of Health Conference on Hepatitis C, held March 24-26, 1997, in Bethesda, Maryland An important cofactor of disease severity appears to be alcohol and alcohol should be avoided in those with chronic HCV infection.” - “Natural History and Clinical Aspects of HCV Infection.” H.J. Alter. Department of Transfusion Medicine, National Institutes of Health, Bethesda, Maryland. Cancer Biotechnology Weekly, 01-29-1996, pp 20. --- VI.2.0 TOBACCO Cigarette smoking combined with the hepatitis C virus is known to be a heavy risk factor in developing primary hepatocellular carcinoma. (Int J Cancer 2000 Feb;85(4):498-502).
While many people are aware of smoking's negative effect on the lungs, less consideration is usually given to its effects on the liver. Tobacco and marijuana smoke are rich airborne stews of toxic benzpyrene, polycyclic aromatic hydrocarbons, cyanide, acetaldehyde, tars, acrolein, etc. Since these get into the bloodstream through the lungs, the liver must detoxify them. And virtually all the constituents of smoke are known to be at least mildly liver-damaging (The Liver: Master Organ for Optimal Nutrition).
A recent study biopsied 310 Hep C patients. 176 were current smokers (who were more often males, younger, alcohol consumers, and more often had a history of IVDU than those who had never smoked.) The results were adjusted to consider these factors. The authors concluded that “Smoking increases the severity of hepatic lesions in patients with chronic hepatitis C.” Source: Hepatology 2001;34:121-125, “Cigarette smoking and hepatic lesions in patients with chronic hepatitis C.” --- VI.3.0 MARIJUANA There are plenty of conflicting studies on the benefits/ dangers of marijuana use by the chronically ill. Recent studies show that marijuana can be beneficial for those with AIDS The results of a study released at the XIII International AIDS Conference reports that smoking marijuana helps people with AIDS gain weight, without causing adverse virologic effects (July 2000). But HIV is not HCV. Nor is HCV Cancer, nor are the aches and pains of HCV commensurate with the pain of someone who is dying of a debilitating illness. Other studies (May 2000) speak of the synthetic marijuana derivative CT-3 as an anti-inflammatory and analgesic therapy intended as a safer alternative to nonsteroidal anti-inflammatory drugs (NSAIDs), the most commonly prescribed analgesic and anti-inflammatory therapy for long-term treatment of arthritis.
One recent studies state that marijuana use increases tumor growth, and another links it to emphysema.
A report from the New South Wales Users and AIDS Association “Hepatitis C and Drug Use” states that marijuana presents no problems for the liver; another report warns that marijuana may interact adversely with antidepressants.
It has been shown that marijuana interferes with the effectiveness of interferon alfa-2a in the treatment of genital warts due to drug-induced impairment of cellular immunity. (“Genital Warts do not respond to systemic recombinant interferon alfa-2a treatment during cannabis consumption,” Gross G; Roussaki A; Ikenberg H; Drees N., Dermatologica, 1991, 183(3):203-7 ) Whether this is also true for marijuana use during interferon alpha-2b treatment for hepatitis is unknown. --- VI.3.1 COCAINE A study of blood donors who showed traces of past infection with the liver-damaging disease hepatitis C has uncovered a possible link between the infection and snorting cocaine. Snorting “could be an unrecognized route” for the hepatitis C virus to get into the body, said a team of medical researchers led by Dr. Cathy Conry-Cantilena of the National Institute of Allergy and Infectious Diseases. But the researchers noted that cocaine abuse may not be the actual cause of the hepatitis. Cocaine users may simply be more prone to other behaviors that make them vulnerable to the infection. Hepatitis C is usually passed via contaminated blood. The researchers said it was possible the straws used to snort the drug could be tainted with blood and the virus could get into a user’s body through the wall of the nose, which is often damaged in cocaine snorters. --- VI.4.0 WHAT ARE THE EFFECTS OF RECREATIONAL DRUGS? If you are HCV+, alcohol and other drugs are likely to put added strain on your already stressed liver. And even if you already have HCV, you are still open to re-infection if you expose yourself to the virus through unsafe drug use. There are several different types and variations of HCV, and every time you catch a different type, it is like you have been infected for the first time. People with multiple infections of HCV are often the ones who become sicker. It is advisable to avoid alcohol and all street drugs. If users are opiate dependent methadone may be an alternative in this phase of infection, simply because it is available in pure form. Hepatitis generally increases the chances of overdosing (especially on alcohol, and benzodiazepine tranquilizers such as Serepax, Rohypnol, Valium, Mogadon and Temazepam) because the liver cannot handle the doses of drugs to which the user was formerly accustomed. Serepax is better than other benzodiazepines but it still presents problems. Heroin is relatively harmless during hepatitis infection but all drugs present problems, whether in pure or impure forms. Amphetamines and benzodiazepines are medium destructive and alcohol is the worst. In as far as drug use is concerned, purer forms of drugs are advisable in all cases (for instance methadone is better than street heroin, pharmaceutical amphetamines are better than street amphetamines) but this is only a minor improvement, for it is the liver’s function of removing drugs from the body which is affected by the hepatitis C virus. It is best to be aware of any possible problem in this area and the specific relationship between specific drugs and the liver. It is best to be entirely drug free during the acute phase of hepatitis infection so that the liver can repair itself. Drug-taking presents less problems if you have a healthy liver. - New South Wales Users and AIDS Association “Hepatitis C and Drug Use” --- VI.4.1 INTRAVENOUS DRUG USE PRECAUTIONS When injecting drugs, the best protection is to never re-use injection equipment. Cleaning injection equipment is not guaranteed to kill the hepatitis C virus. To avoid hepatitis C when injecting: · have a fit, spoon, water, filter, swab and tourniquet · wash your hands with warm soapy water before and after injecting · clean the spoon with a fresh swab · keep all your utensils separate from your friend’s utensils · inject yourself - but if someone else does inject you, make sure he/she has washed his/her hands · if you get blood on your hands, go and wash them before you touch anything on the table - if someone asks you to pass them something, tell them to wait. · if you do touch something before you’re able to wash your hands, treat it as contaminated · dispose of your used fits, filters, swabs, etc, properly by putting them into a sharps container - or use an empty plastic drink bottle or detergent container. (Look for the letters PET on the bottom of the plastic bottles, as these are especially strong.) Be careful not to dispose of your fits in aluminum cans or glass bottles. Kids collect cans for recycling and could get needlesticks, and glass bottles can easily break. · remember - use new equipment every time. Cleaning equipment doesn’t always kill the hepatitis C virus. · remember - wash your hands with soap and water before and after injecting. You can’t always see minute amounts of blood. · remember - make the bench or table where you’re injecting as clean as possible. --- VI.4.2 CLEANING FITS We don’t know that disinfection or cleaning really works so be safe and use all new equipment every time you hit up. Reusing fits should be a last option only. If you’re cleaning fits, remember the following guidelines: · Immediately after use, rinse fit in cold water until signs of blood are gone. Squirt water down sink or into an old drink bottle. · Do this as soon as you’ve used the fit since dried or clotted blood is hard to wash out and can block the fit. Always use cold water as hot water will clot blood in the fit and block it. · Fill the fit with fresh high-strength bleach. Use the strongest bleach available (which is usually the most expensive). With the fit full of bleach, replace the cap over the needle and shake it for 30 seconds or more. Time this on a watch or count it out slowly. Then squirt the bleach out into the sink or an old drink bottle. Now repeat the bleach process, again shaking for thirty seconds. · With another container of fresh clean water rinse the fit out at least two times. Again, squirt the water down the sink or into an old drink bottle, not into your containers of bleach or clean water. Empty all your containers down the sink when you are finished.
Remember that this way of cleaning fits can’t be guaranteed to kill the hepatitis C virus. - Hepatitis C Council of NSW --- VI.4.3 METHADONE AND HEPATITIS C The effects of methadone can alleviate possible painful symptoms of hepatitis C. Although this may be helpful, it can camouflage early signs of liver damage (if it develops). Flu-like hepatitis C symptoms may give the impression that you are on prescription pills. If this causes problems at the clinic where you receive your methadone, it may be useful to remind them of the complicating effect of hepatitis C symptoms. If you experience flu-like symptoms of hepatitis C, these symptoms should not be misinterpreted as withdrawal symptoms from opiates. People should be careful with methadone dosages and aware of their real tolerance for drugs. This is especially important if liver damage is severe. - Hepatitis C Council of NSW
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Reviewed March 2004