~Hepatitis C, Part 7 - Summary and Integrated Protocol


HCV infection is one of the leading causes of liver disease and one of the major risk factors for developing cirrhosis and hepatocellular carcinoma. The majority of infections become chronic, but the spectrum and progression of disease associated with HCV is highly variable. The particular genotype of the virus influences the choice of treatment and ultimate outcome of the disease. There is no vaccine and conventional treatment options are limited. All current conventional treatments are based on synthetic interferon-a—a combination of pegylated interferon and ribavirin is the most effective treatment available to date. Many people who become HCV-infected are immediately excluded from this treatment because of contraindications to interferon. Of the group than can take interferon, many will not respond to treatment; or they will respond and then relapse. The success rate of retreatment with interferon-a is so low that is not an option except in clinical trials.

The theory behind the pegylated interferon and ribavirin combination is scientifically sound: mimic the body's own endogenous interferon to boost the immune system and, at the same time, use ribavirin drug to kill the virus. But there is a general agreement that less-toxic and more virus-specific treatments must be developed. There is also a need for better treatment of the principal complications of CHC and the side effects of interferon. Alternative therapies and multifaceted treatment strategies based on scientific evidence that are directed at bolstering the immune system are a welcome addition to the armamentarium of treatments for CHC.

After infection with HCV, the body's endogenous cytokines mount a defense to combat the virus, indirectly through the immune response and directly through inhibition of viral replication. Pro-inflammatory cytokines, such as interferon and interleukin, produce antiviral immune responses; and that HVC-induced oxidative damage to the liver is due to pro-inflammatory cytokines. A healthy immune system and an appropriate ratio of pro-inflammatory and anti-inflammatory cytokines can improve overall health by combating the virus directly and by increasing the effectiveness of pegylated interferon and ribavirin. Several alternative treatments have demonstrated an ability to increase the response rate of conventional treatment, and many can lower or normalize ALT levels. Epidemiologic studies show that many patients with persistently normal ALT levels do well and do not develop severe cirrhosis or liver cancer.

The nutritional and botanical treatment regimes discussed in this protocol, coupled with a healthy lifestyle, can improve the functioning of the immune system by increasing antioxidant levels in the body and thus minimize damaging effects of free radicals to liver cells.

  • Nutritional Recommendations
  • Lifestyle Modifications
Nutritional Recommendations

Conventional therapy consists of weekly injections of peginterferon alfa-2b (pegylated interferon) along with a prescribed dose (usually 800-1200 mg a day) of ribavirin (Rebetol). The treatment interval used with these two drugs is determined by the physician.

Iron promotes hepatitis virus-induced liver injury and precludes successful treatment with interferon. Verify that liver iron levels have been reduced before starting interferon therapy. To sufficiently reduce iron levels, some patients require withdrawal of blood before beginning interferon-ribavirin therapy. (HCV patients cannot donate blood; therefore, this blood must be discarded.) Be certain that serum iron levels are at the lowest possible tolerable levels (ideally below 60 mcg/dL of blood) while serum ferritin levels should be maintained in the low normal range of 30-80 nanograms/dL. As long as symptoms of anemia do not appear, lower iron as much as possible (under a physician's supervision).

To block iron absorption and lower iron levels, take:
  • Calcium citrate, one to two 1000-mg capsules with iron-containing foods
  • Lactoferrin, (apolactoferrin form) one 300-mg capsule 3 times daily (Lactoferrin is also a potent immune-boosting agent.)
To reduce oxidative stress by boosting liver cell glutathione levels, take:
  • R+Dihydro-lipoic acid, 150 mg capsule 3 times daily
  • N-Acetylcysteine (NAC) – 600 mg capsule once daily
  • Whey protein isolate, 20-40 grams daily
  • Glutathione, 500 mg capsule once a day on empty stomach
  • Methylcobalamin (Vitamin B12) – 5 mg tablet once daily sublingually
  • Silibinin extract, 250 mg capsule 3 times daily
To protect and restore liver function by facilitating healthy methylation patterns in the liver critical for life-sustaining enzymatic actions take:
  • SAMe, 400 mg tablet 3 times daily.
Additional methylation-enhancing agents that work synergistically with SAMe are:
  • Trimethylglycine (TMG), 1000 mg twice daily
  • Folic acid, one 800 capsule mcg 3 times daily (combined with methylcobalamin (B12) in the dosage ratio of 800 mcg folic acid and 300 mcg of vitamin B12).
The following choline-containing nutrients enhance the effects of interferon, maintains the stability of liver cell membranes, and are methyl-sparing because they provide preformed methylated compounds.
  • HepatoPro (Polyenylphosphatidylcholine) in a dose of 900 mg daily
  • CDP-Choline in a dose of 250 mg daily.
  • Alpha glycerylphosphorylcholine (GPC) in a dose of 600 mg daily.
  • Lecithin Granules in a dose of 10 grams daily.
  • Phosphatidylserine in a dose of 100 mg daily.
  • Creatine in a dose of 2,000 to 3,000 mg daily.
To provide antioxidants and natural antiviral agents directly to liver cells, take:
  • Green tea extract, 2 capsules at breakfast and 2 capsules at lunch (Green tea also helps block iron absorption.) Each capsule should be standardized to provide at least 100 mg of epigallocatechin gallate (EGCG). The EGCG fraction of green tea provides the greatest antioxidant and anticancer effects.
  • Garlic, 2700 mg once daily (a high-allicin, 10,000-ppm garlic supplement with food). If stomach irritation or pungent odor causes a problem, take 1000 mg of aged Kyolic garlic extract.
  • Grape seed-skin extract (85-95% proanthocyanidin), 100 mg 2-3 times daily.
  • Selenium, 200-600 mcg once daily.
To maintain youthful immune function, take:
  • DHEA – 15-50 mg once daily sublingually. See DHEA Replacement Protocol for specific information.
  • Life Extension Herbal Mix – Standard dose
  • Life Extension Mix – Standard dose
The standard doses of Life Extension Mix and Life Extension Herbal Mix. Please note that some hepatitis C patients encounter liver enzyme elevations in response to moderate doses of vitamin A, niacin, and beta carotene in Life Extension Mix. If your liver enzyme levels elevate after using Life Extension Mix, discontinue it and take the other nutrients contained in Life Extension Mix. Beta carotene possesses unique immune-enhancing benefits that could help suppress the hepatitis C virus, but some hepatitis C patients cannot tolerate it.

Lifestyle Modifications
  • Do not drink alcoholic beverages. Hepatitis C patients are especially vulnerable to its damaging effects. The liver of hepatitis C patients is especially vulnerable to the damaging effects of alcohol.
  • Eat more fresh fruits, vegetables. Foods high in fiber have less saturated and trans fats. These foods naturally provide the many minerals, vitamins, and essential fatty acids we recommend below, and many other beneficial natural substances we have yet to define.
  • Reduce stress on and off the job.
  • Exercise regularly and keep your weight within normal limits.
If your doctor prescribes medicine to treat your HCV infection, be sure to follow his directions precisely. Make sure he knows all the prescribed and over-the-counter medicines you are taking. The following drugs are some that might be prescribed:
  • Branded Interferon
  • Peginterferon (40KD) (Pegasys®; Roche Laboratories; Nutley, New Jersey)—40-KD branched peg chain.
  • Pegylated interferon-2b (12KD) (PEG-Intron™; Schering-Plough; Kenilworth, New Jersey)—12-KD linear peg chain
  • Unmodified interferon (Roferon-A®, Intron A®).
  • Branded Ribavirin
  • Rebetron™
  • Standard Doses for Chronic hepatitis C
    • Interferon 3 million IU sc three times weekly + oral ribavirin 1200 mg daily in two divided doses
    • Pegylated interferon -2b monotherapy 1.0 µg/kg, once weekly over 24 weeks
    • IFN alfa-2b 3 MIU 3 times a day
For More Information Contact
  • American Liver Foundation, 800-GO-LIVER (465-4837); E-mail: webmail@liverfoundation.org, http://gi.ucsf.edu/ALF/alf/alfservs&acts.html
  • Hepatitis Foundation International, (301) 622-6400
  • HepC Connection 800-522-HEPC, www.hepc-connection.org
  • American Association for the Study of Liver Diseases, (703) 299-9766; E-mail: aasld@aasld.org http://www.aasld.org/
References . . .

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