Getting Physical - Preparing For Hepatitis C Treatment
Fibrosis, steatosis and insulin resistance was improved with exercise, low-fat or low-calorie diets in people with HCV according to a recent study in the 2013 August issue of "Nutrition Journal."
Ask yourself this; Am I in good medical shape to begin treatment, could I improve anything about my physical self to prepare? .
Question; What did you have for breakfast ?
Answer; Facebook, Twitter a cigarette and a cup of coffee.
Me too, kidding, I never go on twitter before noon. .
Seriously, its time to get in shape before starting treatment. Give yourself the best chance possible at achieving a cure. Engaging in a healthy lifestyle can help avoid obesity, insulin resistance, and diabetes, which is linked to rapid disease progression, higher rates of HCC, and reduced antiviral responsiveness in people with HCV. .
For more information about the host factors related to HCV disease progression, click here
Starting With Alcohol .
Studies have shown that people with HCV who abuse alcohol are more likely to die than those who have hepatitis C and do not drink. People with both alcoholic liver disease and hepatitis C have a higher chance of developing HCC than those with hepatitis C infection alone. Abstaining from drinking alcohol is the most important lifestyle change a person living with the virus should make.
Alcohol contributes to the chronicity of Hepatitis C and the poor efficacy of interferon-based therapy
In the April 2013 issue of Clinical Liver Disease research suggests that alcoholics have inferior rates of response to HCV therapy. View the recent study here.
From Hepatitis Central ; Another Reason for Hep C Patients to Abstain from Alcohol
As published in a June 2010 edition of the journal Drug and Alcohol Dependence, researchers from Philadelphia found that undergoing interferon-based treatment to eliminate Hepatitis C is definitely not a reason to be lax with alcohol abstinence. Currently, the standard treatment for Hepatitis C is combination therapy with pegylated interferon and ribavirin.
Their study investigated whether alcohol impaired the immune function of human liver cells, which would promote Hepatitis C infection and replication. .
The researchers found the following:
Alcohol suppressed natural interferon action in the liver. (Our immune system contains natural interferons to protect us against disease.) Alcohol encouraged suppressors of cytokine signaling, which are negative regulators of interferon expression, thus impeding interferon action. Based on their findings, the authors concluded that drinking alcohol contributes to the chronicity of Hepatitis C and the poor efficacy of interferon-based therapy.
Some people assume that as long as they are not an alcoholic, an occasional drink with Hepatitis C is OK. The evidence clearly indicates this assumption to be incorrect. Any bit of alcohol can worsen Hepatitis C infection and, for those who hope to clear the virus with interferon-based therapy, they shouldn't even bother with the treatment if they plan on drinking any alcohol
Alcohol Consumption And Risk For Death In People With Hepatitis C
"A drink a day is not OK," Younossi told Reuters Health. "Even a moderate amount of alcohol use in the setting of hepatitis C can increase the risk of death and liver-related mortality specifically."
Mortality risk greater among patients with HCV who drank alcohol moderately, heavily
Patients with chronic hepatitis C who drank a moderate amount of alcohol or more were at greater risk for death than controls and patients with HCV who did not drink in a recent study. Younossi and his colleagues looked to a large national survey on health and lifestyle that tracked people for several years. They compared 8,767 people without hepatitis C to 218 people with the disease. The survey tracked the participants for 13 to 14 years. During that period, 19 percent of those with hepatitis C and 11 percent of those without the infection died. Younossi's team found that people with hepatitis C who drank excessively - three or more drinks a day - were five times more likely to die than heavy drinkers who were not infected.
Read more here......
Alcohol and hepatitis C are a dangerous cocktail, USC researchers find
The natural history of HCV infection is influenced by genetic and environmental factors of which chronic alcohol use is an independent risk factor for cirrhosis in HCV-infected individuals. Both the hepatitis C virus and alcohol damage the liver and result in immune alterations contributing to both decreased viral clearance and liver injury. . In 2009 at the Keck School of Medicine researchers found a complex molecular events that link alcoholism and HCV to increased risk of hepatocellular carcinoma (HCC)
Researchers conducted a series of experiments with mice and also examined liver biopsy samples from human patients infected with HCV, and found high levels of the protein NS5A and TLR4. In the subset of patients who were also alcoholics, the researchers saw signs of increased antibacterial response. The research also identified a specific molecule called Nanog, which acts as a stem cell marker in tumor development when activated by TLR4.
“There were several major findings that resulted from this study,” Machida said. “We established a mouse model which will enable us to better understand alcohol and hepatitis C virus infection and we found the signaling that causes tumor development in mice through the receptor TLR4.”
Continue reading...... .
Smoking and Fibrosis
In this older study authors looked at liver biopsies from 310 patients with chronic HCV who were under going their first liver biopsy. They then went on to compare those biopsies with the patients who were current cigarette smokers (176 patients) or former cigarette smokers (56 patients). Last but not least, biopsies from patients who had never smoked (77 patients).
They found that current and former smokers had more inflammation and scarring of their livers than did nonsmokers. This finding could not be explained by other factors, such as concurrent alcohol use, that are known to aggravate the inflammation and scarring in hepatitis C. The authors concluded that smoking cigarettes could worsen their liver disease.
From HIV and Hepatitis .
Alcohol, Tobacco, and Cannabis All May Promote Liver Disease Progression in People with Chronic Hepatitis C .
In 2008 a study suggested that cigarette smoking may enhance activity grade in patients with chronic hepatitis C, thereby increasing progression of fibrosis. This assumption mostly relies on epidemiological evidences in the absence of pathogenic studies.
Are we there yet ? Are you inspired to stop smoking ?
Smoking and Liver Cancer .
NEW YORK (Reuters Health) - There appears to be a synergistic link between smoking and hepatitis C virus (HCV) infection, leading to a more than 136-fold increased risk of hepatocellular carcinoma (HCC) in men, according to a team at The University of Texas MD Anderson Cancer Center.
Well, we have established that cigarette smoking increases fibrosis, how about the increased risk in men for developing liver cancer. Here we go, published in 2008 in the International Journal of Cancer, researchers investigated HCC and the risk factors such as smoking in men and women who have HCV.
· Men with HCV who smoke have a more than 136-fold increased risk of HCC.
· Women with HCV who consume large amounts of alcohol have a more than 13-fold increased risk of HCC.
The facts; smoking increases the risk of liver cancer by over 100 times. Does this inspire you to stop smoking?
While on HCV therapy I was forced to stop smoking. Not because I wanted to, but because I developed a cough that kept me up most nights.
COPD and Treatment
I wanted to take this opportune moment to suggest that if you are over forty and have smoked for more then 15 years you may want to ask for a spirometry; (COPD) test before you begin treatment. Sadly, its a horrendous thing to be diagnosed with, but a good thing to know - period! Especially before starting therapy.
Fatty Liver and HCV
Metabolic steatosis and HCV-induced steatosis
Steatosis (fatty liver)
Steatosis is the build up of fat within the liver. This sometimes triggers inflammation of the liver. It is also known as ‘fatty liver’. It is only recently that the significance and relationship of steatosis to the hepatitis C virus (HCV) has begun to be understood.
There are two different forms of steatosis found in people with HCV. These are metabolic steatosis and HCV-induced steatosis. Metabolic steatosis can result from obesity, raised blood fat levels (hyperlipidemia), insulin resistance and type II diabetes. It is similar to the type of fatty infiltration caused by excessive alcohol consumption and is also found in Non-Alcoholic Fatty Liver (NASH). Metabolic steatosis is not triggered by HCV. The combination of this form of steatosis and the presence of HCV can, however, lead to a more rapid progression of scarring or fibrosis. HCV-induced steatosis is fatty
infiltration that is directly caused by the presence of the virus. It is possible for people with HCV to have both forms of steatosis simultaneously.
Although it appears that all genotypes can trigger steatosis, the risk of developing steatosis is significantly higher for people with genotype 3. There is a complex reaction between the genotype 3 virus and liver cells which is not seen in other genotypes. This places this group at a much higher risk of developing the condition. Around 40% of people with hepatitis C have steatosis, compared to about 14% to 31% of the general population. However, 60% - 80% of people with genotype 3 have moderate or severe steatosis.
Both forms of steatosis increase the risk of disease progression in HCV infection. They also reduce the likelihood of responding to HCV treatment, and may possibly contribute to the development of liver cancer (HCC) in people who
have cirrhosis. It is helpful to know which type of steatosis you might have in order to manage it or to be better placed to decide whether to undergo treatment or not. Whilst there is no direct treatment for steatosis regular exercise and
diet can significantly reduce the amount of fat in the liver. For people with genotype 3, antiviral treatment can often markedly reduce or even eliminate steatosis, but this does not seem to apply to other genotypes.
The causes of metabolic steatosis are not completely understood. So far it is known to be linked to high body mass index (a measure of obesity), altered blood fat levels (e.g., triglycerides, cholesterol), elevated blood glucose, insulin resistance, and type II diabetes.
The condition results in the build up of globules of fat in the liver sometimes accompanied by inflammation. It is also
unclear exactly how the build up of fat damages the liver. A number of different theories of possible mechanisms have been suggested:
- Oxidative damage (when highly reactive oxygen molecules such as free
radicals, produced as a result of the cells’ normal chemical reactions, interact
with other molecules damaging the cells and tissue of the liver).
- Increased susceptibility to apoptosis (when the immune system causes the
death of certain cells to try and protect the rest of the liver).
- Altered liver cell regeneration whereby liver cells regenerate into deformed
On average steatosis is about two and half times more common in people with HCV than in the general population. Biopsy samples in people with HCV who have steatosis tend to show that fat accumulates around the portal areas, rather than
in the middle of the lobules of the liver which is usually the case with Non Alcoholic Fatty Liver Disease (NAFLD). This suggests that it is the virus rather than any other factors which acts as the trigger.
For people with genotype 3 the link between steatosis and the virus has now been specifically established. Up to 80% of people with genotype 3 have moderate to severe steatosis. It seems that a complex interaction occurs between the core
protein of the genotype 3 and the liver cells leading to steatosis. This interaction is not seen in other genotypes. It also seems that the severity of steatosis in these patients is directly related to their viral load. The higher the viral load the greater the amount of steatosis. This link has not been observed in other genotypes.
Sometimes people with genotype 3 who achieve sustained virologic response (SVR) through treatment have a marked decrease in and sometimes a complete resolution of steatosis. If they relapse though, steatosis reappears. People
with other genotypes show no improvement in the level of steatosis after successful treatment.
Steatosis and progression of HCV
It is not yet clear whether metabolic steatosis or HCV-induced steatosis both carry the same level of risk of increasing the disease’s rate of progression. It is well known that there is a definite link between the severity of steatosis and the extent of scarring on the liver. Recent studies have shown that higher grades of steatosis relate to higher grades of scarring with more rapid development of fibrosis and cirrhosis.
Steatosis is also known to reduce the likelihood of responding to HCV
treatment. It may also contribute to the development of liver cancer (hepatocellular carcinoma, or HCC) in those with cirrhosis. Few studies have yet separated the two types of steatosis when examining its affects on fibrosis progression in people with HCV. It has been suggested, but not confirmed, that when people with genotype 3 have both forms of steatosis, the combination may trigger severe advancement of fibrosis.
Read more On Steatosis (fatty liver) @ Hepatitis C Trust
Hepatitis C Virus Diversity and Hepatic Steatosis
Fatty Liver and You, What Can You Do ?.
Lose weight; If you're overweight or obese, reduce the number of calories you eat each day and increase your physical activity in order to lose weight.
Aim to lose 1 or 2 pounds a week. If you've tried to lose weight in the past and have been unsuccessful, ask your doctor for help.
Choose a healthy diet; Eat a healthy diet that's rich in fruits and vegetables. Reduce the amount of saturated fat in your diet and instead select healthy unsaturated fats, such as those found in fish, olive oil and nuts. Include whole grains in your diet, such as whole-wheat breads and brown rice.
Exercise and be more active; Aim for at least 30 minutes of exercise most days of the week. Incorporate more activity in your day. For instance, take the stairs instead of the elevator. Walk instead of taking short trips in your car. If you're trying to lose weight, you might find that more exercise is helpful. But if you don't already exercise regularly, get your doctor's OK first and start slowly.
Control your diabetes; Follow your doctor's instructions to stay in control of your diabetes. Take your medications as directed and closely monitor your blood sugar. .
Lower your cholesterol; A healthy plant-based diet, exercise and medications can help keep your cholesterol and your triglycerides at healthy levels.
Protect your liver; Avoid things that will put extra stress on your liver. For instance, don't drink alcohol. Follow the instructions on all medications and over-the-counter drugs.
Insulin Resistance And HCV
Metabolic factors and chronic hepatitis C: a complex interplay
In this review, we discuss the most recent lines of evidence on the main metabolic factors that are known to be associated with CHC, namely, insulin resistance/type 2 diabetes, steatosis, visceral obesity, atherosclerosis, vitamin D, menopause, fructose and coffee intake, lipoproteins, methylenetetrahydrofolate reductase status, and hyperuricaemia.
Medications to address insulin resistance
Insulin resistance is associated with a poorer treatment response in standard HCV therapy. Experts advise managing this complication by prescribing medications to address insulin resistance. One medication is the oral drug Metformin, a study in 2008 looked at adding Metformin to standard therapy.
Therapies to Manage Insulin Resistance Improve Response to Interferon-based Therapy in Chronic Hepatitis C Patients .
The results from the study showed people who received metformin in combination with pegylated interferon/ribavirin had a better outcome than those without metformin, with women having a more dramatic reduction in their viral load than men. Although using metformin along with pegylated interferon/ribavirin may not be the solultion for everyone, research has confirmed maintaining your blood sugar will hinder the progression of liver disease and increase the likelihood of achieving SVR.
Surprising Findings About Hepatitis C and Insulin Resistance .
ScienceDaily (Mar. 10, 2010) In studying the insulin resistance of 29 people with Hepatitis C, Australian researchers have confirmed that they have high insulin resistance, a precursor to diabetes. However, almost all insulin resistance occurs in muscle, with little or none in the liver, a very surprising finding given that Hepatitis C is a liver disease.
Insulin, a hormone made by the pancreas, helps the body use glucose for energy. The two most important organs that respond to insulin are the liver and muscle. A healthy liver responds to insulin by not producing glucose, while healthy muscle responds by using glucose. An insulin resistant liver produces unwanted glucose, while insulin resistant muscle cannot absorb it from the bloodstream, leading to high levels of sugar in the blood. .
Fatty Liver - Contrary to all expectations, not only did we find no significant insulin resistance in the liver of the patients in the study, half of them suffered from a strain of Hepatitis C that causes about three times the normal level of fat to accumulate in the liver," said Professor Chisholm. "he fifteen people with very high levels of fat in the liver had the same degree of insulin resistance as the fourteen that didn't have fatty livers." The extra insulin resistance caused by Hepatitis C apparently brings on diabetes at 35 or 40, instead of 65 or 70." ."In our study, we gave intravenous glucose, a specific stimulus to insulin secretion, and showed that insulin secretion was not impaired in Hepatitis C patients compared to our control group."
"This finding tells us that people with Hepatitis C who develop diabetes probably have susceptible insulin-producing cells, and would probably get it anyway -- but much later in life. The extra insulin resistance caused by Hepatitis C apparently brings on diabetes at 35 or 40, instead of 65 or 70." "At this stage, it is helpful for people with Hepatitis C to understand insulin resistance and what it can mean for them. If they have relatives with Type 2 diabetes, they will be genetically prone to developing it themselves and so would be advised to manage their diets very carefully and take plenty of exercise -- to slow onset."
Also See getting to the root of fatty liver disease
Insulin Resistance - Why Manage Your Diet and Exercise?
As the study suggested if you have a family history of type II diabetes then you are prone to develop the disease, researchers have preached that changes in diet and exercise reduced the development of type II diabetes by 58%.
Lose weight.; Losing as little as 5 to 10 percent of your body weight can reduce insulin levels and blood pressure, and decrease your risk of diabetes. .
Exercise; Doctors recommend getting 30 to 60 minutes of moderate-intensity exercise, such as brisk walking, every day. .
Stop smoking; Smoking cigarettes increases insulin resistance and worsens the health consequences of metabolic syndrome. .
Eat fiber-rich foods. Make sure you include whole grains, beans, fruits and vegetables in your grocery cart. These items are packed with dietary fiber, which can lower your insulin levels. .
Stop the sugar, fats, and anything wrapped up to go.
Click here to Check It Out Folks.
Rather you're getting ready to treat with telaprevir or boceprevir, or waiting for future interferon-sparing therapies, start now to prepare your mind, body and soul for treatment. Begin by walking instead of smoking, eat lean instead of mean, read instead of watching TV, and work the body, instead of the computer.
Wishing you all a successful, healthy and safe HCV journey.