Research & Treatment News
October 31, 2007
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Researchers have proven carbohydrates with a high glycemic index cause fat to accumulate in the liver. By stabilizing blood sugar levels, suggestions are given to reduce the risk high glycemic foods pose, thus minimizing the growing threat of fatty liver disease.
by Nicole Cutler, L.Ac.
For those of us living with liver disease, there appears to be an endless supply of warnings against which foods to avoid, habits to break and activities to dodge. It seems the healthy lifestyle revolution was created exclusively for those with an impaired liver, giving no mercy to people with cravings or personal preferences. Although a common food category in the American diet has been added to our list of things to avoid, healthcare experts have assembled some tips to help people minimize their intake of certain carbohydrates.
Nutritionists have known for a long time that foods with a high glycemic index foster weight gain, and when dominant in the diet may even spawn adult onset diabetes. Confirming their negative impact on health, researchers from Children’s Hospital Boston have recently demonstrated a linear relationship between carbohydrates with a high glycemic index and a fatty liver.
Glycemic Index
Over the last 30 years, research into food and blood glucose response has completely changed our carbohydrate classification system. By measuring how quickly foods are digested and absorbed, the glycemic index measures the body’s response to carbohydrates. The rate at which carbohydrates elevate blood sugar defines a food’s glycemic measurement:
· High – Carbohydrates with a high glycemic index are absorbed quickly into the blood stream and cause a rapid rise in blood glucose levels. This demands a quick response from the pancreas to release insulin for the metabolization and storage of the sugar. Over time, consumption of high glycemic foods stresses the pancreas and the immune system by causing the blood sugar highs and lows endemic to diabetes and hypoglycemia. A glycemic value of 70 or more is considered high.
· Low – Foods with a low glycemic index are broken down more slowly into simple sugars, keeping blood glucose levels more stable. The absorption of these foods is therefore more gradual and does not contribute to blood sugar highs and lows.
The Research
Associate professor of pediatrics and director of the Optimal Weight for Life program, David Ludwig, MD, PhD of Children's Hospital in Boston led the research suggesting that high glycemic foods pave the way for fatty liver disease. “Our experiment creates a very strong argument that a high-glycemic index diet causes, and a low-glycemic index diet prevents, fatty liver in humans,” stated Ludwig.
Published in the September 2007 issue of Obesity, this study investigated the effect of feeding mice either a high or low glycemic index diet containing a type of cornstarch that was either quickly or slowly digested. Diets were then controlled to contain equal calories, fat, protein and carbohydrates. Ludwig and co-workers report that, after six months, the mice weighed the same. However, the differences between the mice were as follows:
· Those on the low glycemic index diet were lean, with normal amounts of body fat.
· Those fed the high glycemic index diet had double the normal amount of fat in their bodies, blood and livers.
According to Ludwig, the mechanism behind the apparent damage of consuming a high glycemic index diet is the increased production of insulin. Instructing the body to make and store fat, insulin is most concentrated in the liver. Fat in the liver increases a person’s risk for liver inflammation, which can ultimately cause liver damage.
Preventing a Fatty Liver
While many lifestyle adjustments are touted for improving liver health, two ways of preventing fat accumulation in the liver are choosing low glycemic instead of high glycemic foods and supplementing with milk thistle to reduce insulin resistance.
By choosing low glycemic foods, sharp swings in blood sugar are avoided, thereby naturally decreasing the body’s production of insulin. Some popular high glycemic foods to restrict in your diet are:
· Potatoes
· Corn
· White flour
· Rice – white or brown
· Refined sugar – white or brown
· Watermelon
· Most refined breakfast cereals
Some popular low glycemic foods to increase in your diet are:
· Apples or pears
· Yams
· Nuts
· Legumes
· Whole grains (especially barley and oats)
· Agave or stevia
In addition to choosing your carbohydrates carefully, supplementing with milk thistle offers an additional level of protection against fat accumulation in the liver. The regular use of milk thistle decreases insulin resistance, where normal amounts of insulin are inadequate to normalize blood sugar.
According to a study published on October 30, 2006 in Phytotherapy Research, Iranian researchers demonstrated that milk thistle seed extract helped control blood sugar for people with type 2 diabetes. In this double-blind study, diabetics taking milk thistle for four months showed better blood sugar control, cholesterol and triglyceride levels than the control group. This research shows that milk thistle can help stabilize swinging blood glucose levels to prevent the accumulation of insulin and therefore fat in the liver.
In order to thwart the burgeoning numbers of people with fatty liver, a better understanding of beneficial carbohydrates is needed. Since consuming lots of high glycemic foods such as bread, cake and rice contributes to a fatty liver, those concerned with liver health are better off choosing low glycemic foods. The more we protect our liver’s health by supplementing with milk thistle and eating low glycemic carbohydrates, the further away a fatty liver disease epidemic becomes.
References:
http://naturalmedicine.suite101.com, The Who’s Who of Sugars, Victoria Anisman-Reiner, August 2006.
http://ukpress.google.com, Diet Link to Liver Disease, The Press Association, 2007.
www.bodybuildingforyou.com What is the Glycemic Index (GI)?, Gary Matthews, bodybuildingforyou.com, 2007.
www.childrenshospital.org, Quick-Burning Carbs May Cause Fatty Liver, Children’s Hospital Boston, September 2007.
www.ehow.com, How to Avoid High Glycemic Foods, eHow Inc., 2007.
www.foodnavigator.com, High GI Diets May Increase Fatty Liver – Study, Decision News Media SAS, September 2007.
www.nccam.nih.gov, Milk Thistle, National Institutes of Health, 2007.
www.nursingpractice.com, Liver Disease Link to Carbohydrates, Campden Publishing Limited, September 2007.
www.webmd.com, Milk Thistle May Help Treat Diabetes, Miranda Hitti, WebMD Inc., 2007.
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Although just a preliminary study, New York researchers have discovered a new use for a well-known diagnostic tool. Useful for evaluating more than just soft tissue injuries, this recent study supports MRI technology as an effective non-invasive method to replace or supplement liver biopsy.
MRI Predicts Liver Fibrosis, Study Says
www.sciencedaily.com
ScienceDaily (Oct. 29, 2007) — Moderate to severe chronic liver disease can be predicted with the use of diffusion-weighted MRI (DWI), according to a recent study conducted by researchers at New York University Medical Center in New York, NY.
"Due to the increased incidence of chronic hepatitis in the United States, particularly hepatitis C, there is a strong need for non-invasive methods to replace or supplement liver biopsy, which is relatively invasive and limited by interobserver variability and sampling error," said Bachir Taouli, MD, lead author of the study. "DWI appears promising in that purpose, although it needs validation in larger series," he said.
The study included 23 patients with chronic hepatitis and 7 volunteers. The researchers compared apparent diffusion coefficients (ADCs) or the quantification of water diffusion in a tissue between patients who had stage 2 or greater versus stage 1 or less fibrosis and stage 3 or greater versus stage 2 or less fibrosis. In liver fibrosis and cirrhosis, decreased ADC (i.e. restricted water diffusion) is possibly related to increased collagen deposition and decreased perfusion. The study showed that hepatic ADC was a significant predictor of stage 2 or greater and stage 3 or greater liver fibrosis.
"At this point, this is an experimental method that needs to be tested in a larger series. It should also be compared with other methods such as FibroTest (a score based on a combination of basic serum markers) or FibroScan (an ultrasound based method to measure liver stiffness) in order to be validated," said Dr. Taouli. "However, diffusion imaging does show potential for decreasing the number of biopsies and decreasing the number of antifibrogenic drug trials," he said.
"We did not expect to have such good results in terms of detection of significant fibrosis, partly because this is an investigational study and we did not have any prior experience with such application," said Dr. Taouli.
"This preliminary study was funded by a grant from the Society of Gastrointestinal Radiologists and we are now in the process of applying for extramural funding from National Institutes of Health," said Dr. Taouli. "The goal is to validate diffusion and perfusion imaging as a replacement of liver biopsy in chronic viral hepatitis," he said.
The full results of this study appear in the October issue of the American Journal of Roentgenology, published by the American Roentgen Ray Society.
Adapted from materials provided by American Roentgen Ray Society.
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October 30, 2007
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Learn about the effect of alcohol on Hepatitis C, and whether or not its consumption, in any moderation, poses risks for people managing the virus.
by Nicole Cutler, L.Ac.
Conflicting research about alcohol’s benefits has cast a shadow of doubt over advice to completely abstain from drinking alcohol. For every article about the benefits of alcohol consumption, another seems to warn of its risks. The debate gets even trickier when deciding to drink an occasional glass of wine while managing Hepatitis C. Although there is no doubt that heavy alcohol use worsens Hepatitis C infection, many social drinkers wonder if this same warning applies to them.
Hepatitis C Progression
The majority of people with chronic Hepatitis C will never develop a major complication related to this disease. Because Hepatitis C is a slowly progressing virus, signs of hepatic inflammation don’t typically appear until 10-20 years after initial exposure. However, if undetected, ignored or untreated, Hepatitis C is more likely to develop into cirrhosis or liver cancer.
Once infected with Hepatitis C, the most prominent risk factor for developing cirrhosis and liver cancer is drinking alcohol. Compared to non-drinkers, regular alcohol consumption significantly raises the risk of developing cirrhosis and liver cancer from Hepatitis C. It is now known that alcohol use, even in socially accepted amounts, accelerates the course of liver disease.
Benefits
Confusing the issue of social drinking, published studies are increasingly supporting consumption of alcoholic beverages. The touted health benefits of moderate alcohol consumption, defined as two drinks a day if you’re a male under 65, or one drink a day if you’re a female or a male over 65, include:
· Reduces risk of developing heart disease, peripheral vascular disease and intermittent claudication
· Reduces the risk of dying of a heart attack
· Possibly reduces risk of strokes, particularly ischemic strokes
· Lowers risk of developing gallstones
· Possibly reduces risk of diabetes
No Justification
With such fantastic health benefits, even a person with Hepatitis C can find justification for infrequent or moderate drinking. However, these benefits do not apply to a person with any kind of chronic liver disease, especially Hepatitis C! If you identify with taking an occasional alcoholic drink with Hepatitis C, consider this perspective – being infected with Hepatitis C is like harboring smoldering coals in your liver. A sip of alcohol is like putting a drop of lighter fluid on those coals. While repeated dumping of lighter fluid will fuel an increasingly raging inferno, even a small amount can fan the fire. Drinking just a little bit of alcohol can push a low Hepatitis C viral load into the far upper registers.
The Evidence
Immunology researchers have demonstrated that alcohol promotes the proliferation of the Hepatitis C virus in human liver cells. By studying molecular mechanisms in cell cultures, Philadelphia researchers revealed the role of alcohol in aggravating Hepatitis C infection and interfering with drug treatment. “It was already known that habitual alcohol drinkers have higher blood levels of Hepatitis C virus, compared to infrequent drinkers, even when both are infected with the virus,” said Wen-Zhe Ho, M.D., the director of retroviral research at The Children's Hospital of Philadelphia.
Three discoveries resulted from studying alcohol’s effect on the Hepatitis C virus:
1. Nuclear factor kappa B – Ho’s research team clarified why alcohol consumption parallels high Hepatitis C viral loads. The researchers found that alcohol increases the activity of a protein called nuclear factor kappa B. Increasing the activity of this specific protein causes the Hepatitis C virus to replicate. Additionally, nuclear factor kappa B plays a role in hepatic inflammation.
2. Interferon-alpha therapy – On a molecular level, the researchers found that alcohol interferes with the antiviral activity of interferon-alpha. By making interferon less effective against the virus, alcohol defeats the purpose of attempting viral eradication with medication therapy.
3. Naltrexone – Another finding with potential implications for Hepatitis C treatment was that naltrexone, a drug used to help alcoholics avoid relapse, blocks the deleterious effects of alcohol in promoting Hepatitis C infection. According to Dr. Ho, both alcohol and morphine activate opioid systems present in liver cells. These systems produce natural opiates, which play a crucial role in drug and alcohol addiction. This process may explain why naltrexone, which blocks opiates from binding to their receptors on cell membranes, reduced the effects of alcohol on Hepatitis C viral replication. “These data strongly suggest that activation of the endogenous opioid system is implicated in alcohol-induced Hepatitis C expression,” the authors conclude.
Thanks to the research team at the Children’s Hospital of Philadelphia, there is no longer any confusion as to what amount of alcohol is acceptable for a person with Hepatitis C. Even though moderate alcohol consumption has been associated with some health benefits, any advantages are far overshadowed by alcohol’s acceleration of Hepatitis C viral replication. Unless you are deliberately trying to increase your viral load, no amount of alcohol is okay with Hepatitis C. While the virus is present in your body, avoid alcohol altogether.
References:
Stoller, Eleanor Palo, et al., Alcohol Consumption within the Context of Hepatitis C, Alcohol and Alcoholism, July 2006.
www.alcoholism.about.com, Drinking May Worsen Hepatitis C Infection, University of Philadelphia News Release, About, Inc., 2007.
www.gastro.org, Hepatitis C, American Gastroenterological Association, 2007.
www.hepnet.com, Hepatitis C and Alcohol, Eugene R. Schiff, MD, Schering Canada, Inc., 2007.
www.mayoclinic.com, Alcohol and Your Health: Weighing the Pros and Cons, Mayo Foundation for Medical Education and Research, 2007.
www.nih.gov, Alcohol Increases Hepatitis C Virus in Human Cells, National Institutes of Health, 2007.
www.patients.uptodate.com, Hepatitis C and Alcohol, Sangik Oh, MD, Sanjiv Chopra, MD, UpToDate, Inc., 2007.
www.webmd.com, Bad Mix: Alcohol and Hepatitis C, Jeanie Lerche Davis, WebMD, Inc., 2007.
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October 24, 2007
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Preliminary results from a Phase II trial on Schering-Plough's experimental Hepatitis C drug Boceprevir are promising. If the results of this study prove to be reproducible and the drug is safe, Boceprevir may help many more people defeat the Hepatitis C virus.
Schering says data on hepatitis C drug promising
NEW YORK, Oct 18 (Reuters) - Schering-Plough Corp (SGP.N: Quote, Profile, Research) on Thursday reported promising early results from a mid-stage study involving its experimental hepatitis C drug, boceprevir.
The company said the favorable results were seen in a Phase II trial of patients who had never previously been treated for their infections with the liver-damaging hepatitis C virus.
One group of patients received boceprevir along with Schering-Plough's widely used current dual therapy -- the injectable interferon drug Peg-Intron and anti-viral pill ribavirin -- while another group received only Peg-Intron and ribavirin.
After 12 weeks of treatment, up to 79 percent of patients in the boceprevir group had undetectable levels of the virus in their bloodstreams, compared with 34 percent of those taking only Peg-Intron and ribavirin.
The company noted that the results, although encouraging, were only preliminary. (Reporting by Lewis Krauskopf and Ransdell Pierson, editing by Gerald E. McCormick)
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October 23, 2007
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California biologists have recently discovered that a defense mechanism known to operate in other species also helps humans fight the Hepatitis C virus. MicroRNA interference explains how interferon inhibits Hepatitis C replication and will likely lead pharmaceutical companies on a new path for developing future treatments.
Discovery Of New Antiviral Mechanism Promising For Hepatitis C Treatment
www.sciencedaily.com
ScienceDaily (Oct. 22, 2007) — A team of researchers led by biologists at the University of California, San Diego has discovered a completely new mechanism that mammalian cells employ to fight infections of the Hepatitis C virus, which affects approximately 2.7 million Americans and 170 million people worldwide.
The achievement, detailed in a paper published in the October 18 issue of the journal Nature, could improve current antiviral regimens or result in new treatments that are more effective and possess fewer detrimental side effects for those with the Hepatitis C virus infection, which frequently leads to liver cirrhosis and/or liver cancer.
“Approximately two percent of the human population worldwide is infected with Hepatitis C virus,” said Michael David, an associate professor of biological sciences at UC San Diego who headed the research team. “And about 50 to 80 percent of those people develop persistent infections and are at great risk of developing liver cancer.”
The only approved therapy for Hepatitis C is alpha-interferon, a protein produced by animal cells when invaded by viruses that induces healthy cells to manufacture enzymes that counter the infection. Often alpha-interferon is used in combination with an antiviral drug called ribavirin. However, only 40 to 80 percent of patients respond to this therapy and about half of those who do respond relapse once interferon treatments are stopped. Only about 25 percent of those treated with interferon, which can also induce flu-like symptoms and kidney damage in some patients, rid themselves of the viral infections. Explaining these varying response rates is difficult, since scientists do not fully understand the mechanisms used by alpha-interferon to fight off Hepatitis C virus infection.
What David and his team discovered is that microRNAs, short strands of RNA that interfere with the expression of specific genes, may also be effective against the Hepatitis C virus, because they are used by mammalian cells to reduce the replication of the virus. Their discovery comes as a surprise because while microRNA interference has been known to occur as a defense mechanism in plants and invertebrates, many scientists doubted it was employed by mammalian cells.
David and his group began by identifying microRNAs whose expression is controlled by alpha-interferon, then used computer prediction to identify potentially affected viral RNAs. Hepatitis C virus emerged as a prime candidate and the UCSD researchers--in collaboration with Hepatitis expert Francis Chisari of The Scripps Research Institute--demonstrated that several alpha-interferon induced microRNAs are able to potently inhibit viral infection and replication.
“This is an entirely new antiviral mechanism in mammalian organisms,” said David. “Use of synthetic microRNAs has become a promising strategy of antiviral treatment. However, selecting the ‘right’ sequence is crucial in order to avoid unwanted and potentially dangerous side effects. The microRNAs used by alpha-interferon have been selected by evolution for efficacy and safety,and might therefore provide a sound basis for the generation of new synthetic antivirals.”
“Now that we have identified this new antiviral pathway or mechanism, pharmaceutical companies may be able to design a more effective therapy against the Hepatitis C virus,” said Irene Pedersen, a project scientist working in David’s laboratory who is the first author of the paper.
Other co-authors of the paper are Francis Chisari, Guofeng Cheng and Stefan Wieland of The Scripps Research Institute and Carlo Croce and Stefano Volinia of Ohio State University. The research was supported by grants from the National Institutes of Health.
Adapted from materials provided by University of California, San Diego.
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October 17, 2007
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A potential Hepatitis C vaccine is beginning Phase I trials in Canada and France. Known as TG4040, this gene-based vaccine will be evaluated for safety and immune response in ribavirin/interferon non-responders and those who have yet to attempt Hepatitis C treatment.
New Therapeutic Vaccine May Offer Hope for Chronic Hepatitis C Patients
www.associatedcontent.com
According to a press release, everything is ready and set to test a new vaccine that may offer hope for people who suffer from Hepatitis C and have relapsed after standard treatment.
Standard treatment consists of treatment with Ribavirin and Pegylated-Interferon Alpha for about six months. Some patients may fail at this standard treatment and may have a relapse in the disease. Additionally, and according to the press release, standard treatment is effective in 50% of the patients completing therapy, is lengthy and often poorly tolerated.
Transgene therapeutic vaccine candidate TG4040 (MVA-HCV) is set to be tried (Phase I trial) on approximately 24 patients that are chronically infected with the Hepatitis C Virus (HCV) and who have relapsed after standard treatment. The trial will be done in Canada.
The protocol for this clinical trial class for one subcutaneous injection of TG4040 per week over a 3-week period together with a boost injection at Month 6. Safeety and immunity responses will be the hallmarks of this study.
The safety data, as well as preliminary viral and immunological data, is planned to be available for the public by end of 2008. Another Phase I study of TG4040 is currently being performed in France on 15 Hepatitis C patients who have never received any other therapy for their condition. Preliminary results are expected at the end of 2007.
Hepatitis C is a blood-borne, infectious, viral disease that is caused by a hepatotropic virus called Hepatitis C virus (HCV). An estimated 150-200 million people worldwide are infected with hepatitis C. In the U.S., those with a history of intravenous drug use, inhaled drug usage, tattoos, or who have been exposed to blood via unsafe sex or social practices are increased risk for this disease. Hepatitis C is the leading cause of liver transplant in the United States (Ryan and Ray 2004).
Sixty to Seventy per cent of people infected develop no symptoms during the acute phase (first 6 months). Some patients experience acute phase symptoms but they are usually mild and rarely lead to a specific diagnosis of hepatitis C. Symptoms of acute hepatitis C infection include decreased appetite, fatigue, abdominal pain, jaundice, itching, and flu-like symptoms.
What is TG4040?
TG 4040 is a recombinant MVA vaccine virus containing nucleotide sequences encoding non-structural immunogenic NS3, NS4 and NS5B proteins of the hepatitis C virus.
Who is Transgene?
Transgene is a biopharmaceutical company dedicated to the discovery and development of gene-based therapeutic vaccines and immunotherapy products for the treatment of cancer and infectious diseases. In addition to TG4040, Transgene has other products in the pip-line such as vaccines candidates for Non Small Cell Lung Cancer, Cervical Intraepithelial Neoplasia (CIN 2-3), and Cutaneous B-cell Lymphoma.
Sources:
Transgene extends therapeutic vaccine candidate TG4040 development program against chronic Hepatitis C. Transgene Press Release. URL: http://www.transgene.fr/us/pdf/communique_presse/communiques_divers_2007/PR-US_%20TG4040_01-10-07.pdf
Ryan KJ; Ray CG (editors) (2004). Sherris Medical Microbiology, 4th ed., McGraw Hill, pp. 551-2.
Transgene web site. URL: http://www.transgene.fr/fr/index.php
By Rafael B.
Published Oct 01, 2007
Posted by Editors at 12:51 PM --- Printer-friendly version
October 16, 2007
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Patients with Hepatitis C often experience a chronic dry mouth. Learn ten safe and valuable ways to reduce this uncomfortable symptom.
by Nicole Cutler, L.Ac.
Although sources disagree on how many people are affected, health care professionals recognize that many people with Hepatitis C experience the chronic discomfort of a dry mouth. Known clinically as xerostomia, not having enough saliva to keep the mouth wet can be a serious problem. Luckily, there are some solutions for xerostomia that are safe for those with Hepatitis C.
Xerostomia
Possibly causing problems with tasting, chewing, swallowing and speaking, a chronic dry mouth is often due to inadequate function of the salivary glands. In addition to lubricating the mouth to permit speech, taste and chewing food, saliva also prevents bacteria, viruses and fungi from causing mouth infections. Besides having a mouth that feels like it is stuffed with cotton, xerostomia patients may experience a sore tongue, gums or cheeks, frothy or foamy saliva, bad breath or sensitive teeth.
Gone untreated, a severe case of xerostomia can lead to increased levels of tooth decay and mouth infections. According to Dr. Martin Greenberg, chairman of the department of the School of Dental Medicine at the University of Pennsylvania, “If a patient has a dry mouth, the chance of dental caries (cavities) climbs.”
Drugs and Depression
Whether due to the physical aspects of Hepatitis C, its emotional associations, social impact or the virus’ treatment regimen, many people living with Hepatitis C confront depression. A common side effect of antidepressant medication, xerostomia is often seen in people battling depression. Additionally, depression can have its own influence on personal hygiene. According to Richard Darling, DDS, “One-third of hepatitis patients on medication suffer depression and, thus, impaired perception of self-care. They may take less care of their teeth, and problems will occur.”
While most antidepressants can cause xerostomia, drugs with significant anticholinergic activity are most likely to lead to oral complications. Anticholinergics such as tricyclic antidepressants are frequently implicated in dental problems because they have a prolonged effect on salivary function. Antipsychotic medications and antiparkinsonian drugs are other classes of drugs with anticholinergic properties likely to cause dry mouth. Newer antidepressants such as venlafaxine, reboxetine and the selective serotonin reuptake inhibitors (SSRIs) can also cause dry mouth, but this is likely to be mild and temporary. For those with Hepatitis C on a methadone treatment program, methadone is another substance known to cause xerostomia.
Hepatitis C Specific
For the most part, people with Hepatitis C do not have to worry about dental problems any more than the average person. “A hepatitis patient has the same responsibility to his or her teeth as every other citizen out there,” says Darling. “They simply need to keep their teeth clean and free of plaque.” However, one study published in the Australian Dental Journal in 2000, indicated some evidence showing that people with hepatitis are slightly more prone to tooth decay.
For a person with Hepatitis C who is at the end stage of liver disease, the poor dental health accompanying xerostomia can result in being rejected for a liver transplant. If you are on the transplant list, you already know that you have to be completely free of any dental disease undergoing an operation. “At the Department of Oral Medicine here at the University of Pennsylvania, we have a service where all transplant patients get a full dental evaluation,” says Dr. Greenberg. “We must eliminate any possible oral influences on infection. While dental problems are not as serious with a liver transplant as they might be with a bone marrow transplant, for instance, it is still an important issue.” All transplant centers offer some kind of dental care for their patients, from the smallest sign of infection to having every tooth removed.
10 Tips for Helping Xerostomia
Since saliva acts to protect your teeth from bacteria, there is plenty of reason to avoid a chronic dry mouth. While your doctor and dentist should be aware of your oral health issues, below are ten ways to help restore moisture in your mouth:
1. Regularly sip water and sugarless drinks.
2. During meals, sip water to help with chewing and swallowing.
3. Chew sugarless gum or suck on hard sugarless candy to help stimulate saliva flow.
4. Avoid caffeine, tobacco and alcohol because they all dry the mouth.
5. During the night, use a humidifier.
6. Avoid spicy and salty foods as these can exacerbate a dry mouth.
7. Reduce bacteria and plaque in your mouth by brushing your teeth at least twice a day with fluoride toothpaste and flossing daily.
8. Minimize sugary, sticky foods, and brush immediately after their consumption.
9. Visit your dentist at least twice a year.
10. Discuss a salivary substitute with your healthcare provider.
Even if a liver transplant is not in your near future, the importance of reducing xerostomia goes beyond the motive to minimize bad breath. By recognizing the possible consequences of a chronic dry mouth, you can work towards improving oral health. Taking such an initiative will save you from liver transplant rejection and from the added burden of oral diseases.
References:
Coates EA, et. al., Hepatitis C infection and associated oral health problems, Australian Dental Journal, June 2000.
Henderson L., et al., Oral health of patients with hepatitis C virus infection: a pilot study, Oral Diseases, September 2001.
http://panicdisorder.about.com, What to do About My Dry Mouth, Cathleen Henning Fenton, About, Inc., 2007.
www.australianprescriber.com, Psychotropic Drugs and Dentistry, Michael M Page et al., Australian Prescriber, 2007.
www.hepccouncilsa.asn.au, Hepatitis C and Dental Health, B. Scopacasa BDS FRACDS, E. Coates MDS FADI FICD, R. Logan BDS MDS, Hepatitis C Council of SA, 2007.
www.liverhealthtoday.org, Open Wide, Tamra B. Orr, Liver Health Today, 2007.
www.medterms.com, Definition of Xerostomia, MedicineNet Inc., 2007.
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October 15, 2007
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The lack of clotting factor in hemophiliacs' blood reduces their ability to form clots in the liver, therefore reducing their liver's ability to scar. Israeli researchers propose this to be the reason that Hepatitis C infection is less severe in hemophiliacs.
Is Chronic Hepatitis C Virus Infection More Benign in Patients With Hemophilia?
www.hivandhepatitis.com
Hemophiliacs, who have a bleeding disorder that requires the administration of donated clotting factor, have a high rate of infection with blood-borne viruses including HCV, HBV, and HIV. Such infections were much more common before routine implementation of infection-control measures including donor screening and treatment of blood products.
Liver cirrhosis is associated with the development of thromboses (blood clots) of the intrahepatic vasculature. Because hemophiliacs lack clotting factor, this raises the possibility that HCV-related liver disease progression in hemophiliacs may differ from that of non-hemophiliac patients with hepatitis C.
As reported in the August 2007 American Journal of Gastroenterology, Israeli researchers analyzed liver biopsies from 12 hemophiliacs and 20 non-hemophiliac control subjects with chronic hepatitis C matched for age and sex. The mean ages of the hemophiliacs and the controls were 35 and 40 years, respectively. Biopsy samples were compared for inflammatory activity and fibrosis.
Results
• 6 of the 7 hemophiliac patients (86%) but only 8 of 17 control subjects (46%) were infected with HCV genotypes 1a or 1b, with the remainder having 2b, 3a, or 3b.
• Serum aspartate aminotransferase (AST) levels were lower (44 +/- 13 vs 70 +/- 43 U/L) and partial thromboplastin times (PTT) were longer (49.2 +/- 16.9 vs 31.2 +/- 1.2 s.) in the hemophiliac patients compared with the control subjects.
• Biopsy results showed that histological activity scores (1.9 +/- 0.6 vs 3.6 +/- 2.7) and fibrosis scores (0.3 +/- 0.2 vs 1.5 +/- 1.5) were significantly lower in the hemophiliacs compared with the control subjects.
• None of the hemophiliacs had histological evidence of advanced liver disease (bridging fibrosis or cirrhosis), compared with 30% of the control subjects.
Conclusion
Based on these results, the authors concluded, "HCV infections in hemophiliacs may be less severe than in HCV infected patients without hemophilia."
09/25/07
Reference
N Assy, N Pettigrew, SS Lee, and others. Are Chronic Hepatitis C Viral Infections More Benign in Patients With Hemophilia? Am J Gastroenterol 102(8): 1672-1676. August 2007
Posted by Editors at 9:30 AM --- Printer-friendly version
October 12, 2007
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New research shows that people undergoing treatment for breast cancer have a greater mountain to climb when also infected with Hepatitis C. Breast cancer affects both men and women. Note: October is designated as both Breast Cancer Awareness Month and Liver Awareness Month.
by Nicole Cutler, L.Ac.
Considering how many people are diagnosed with chronic Hepatitis C, along with the likelihood of someone developing breast cancer, treatment for these two illnesses must be compatible. Because Texan researchers have discovered that Hepatitis C infection may impair breast cancer treatment and increase the complications of chemotherapy, improved communication between hepatologists and oncologists is crucial.
Gender and Breast Cancer
Although predominantly occurring in women, breast cancer can also affect men. Many do not realize that just like women, men have breast tissue. At puberty, a girl's ovaries make female hormones (estrogen), causing breast ducts to grow, lobules to form at the ends of ducts and the amount of stroma to increase. During a boy’s puberty, male hormones (testosterone) made by the testicles typically prevent further growth of breast tissue. Although men's breast tissue is mostly composed of ducts, these cells can undergo cancerous changes. In addition, each individual produces varying amounts of hormones that can encourage breast cancer development; women produce varying amounts of testosterone and men produce varying amounts of estrogen.
Breast Cancer Prevalence
Excluding cancers of the skin, breast cancer is the most common type of cancer in women in the United States, accounting for one of every three cancers diagnosed. The chance of developing invasive breast cancer at some time in a woman’s life is about one in seven. It is one of the leading causes of cancer mortality among women in the United States.
One in every 100 people with breast cancer is a man. Unfortunately, breast cancer’s gender preference typically leads to dangerously late detection in men.
Aside from the gap between men and women in initial diagnosis, early detection, intervention and postoperative treatment have decreased breast cancer mortality. The use of mammography for screening has largely contributed to early detection, and aggressive treatments have allowed many people to survive breast cancer.
Hepatitis C Prevalence
Most Hepatitis C diagnoses come as a surprise because of how long a person can live without any indication of this illness. A study by the Centers for Disease Control and Prevention suggests that 4.1 million individuals in the United States are infected with Hepatitis C, and most have chronic infections. However, most academics agree that the current Hepatitis C statistics are underestimated due to the number of new diagnoses that occur each day.
University of Texas Research
Assistant Professor at the University of Texas department of breast medical oncology, P. K. Morrow, MD is a medical oncologist specializing in the treatment of breast cancer patients. As the lead researcher in a study presented at the 2007 American Society of Clinical Oncology Breast Cancer Symposium, Morrow warned, “Hepatitis has wide-ranging effects on treatment of breast cancer.” The researchers indicated in their presentation that poor outcomes of breast cancer treatment are endemic to those also infected with Hepatitis C.
In the small retrospective study of breast cancer patients, Texan researchers found chemotherapy dose delays or required dose reductions in those with Hepatitis C:
· Neoadjuvant Chemotherapy – Given prior to a surgical procedure to shrink the cancer, neoadjuvant chemotherapy effectiveness was reduced by 27 percent in the study’s participants with Hepatitis C.
· Adjuvant Chemotherapy – Given to destroy leftover (microscopic) cells that may be present after the known tumor is removed by surgery, adjuvant chemotherapy effectiveness was reduced by 30 percent in the study’s participants with Hepatitis C.
Although the reason for this effect is not fully understood, Morrow postulated two reasons for a poorer outcome in breast cancer treatment in those dually affected by chronic Hepatitis C:
1. Poor drug metabolism – A person with chronic Hepatitis C is likely to have decreased liver function, thereby making it more difficult to metabolize the toxic chemotherapy drugs used in breast cancer treatment.
2. Myelosuppression – A common side effect of chemotherapy, myelosuppression occurs when bone marrow activity is decreased, resulting in fewer red blood cells, white blood cells, and platelets. The current treatment standard for Hepatitis C, interferon and ribavirin combination therapy is also known to initiate myelosuppression. With a decrease in bone marrow activity, recovery becomes an immense challenge.
In addition, participants with Hepatitis C undergoing chemotherapy for breast cancer had a drastically increased likelihood of treatment complications.
Study Analysis
It makes sense that chemotherapy would be the ultimate challenge for a person with chronic liver disease. Essentially, chemotherapy is the administration of toxic medications to kill cancerous cells. Of course, a person with chronic Hepatitis C must do all they can to protect their liver from any additional toxic burdens. This is likely to explain why a prior study demonstrated that breast cancer treatment for patients with Hepatitis B increased the chance of viral reactivation, early discontinuation of chemotherapy, and treatment delay.
Dr. Morrow urged doctors who treat breast cancer to closely monitor their patients living with Hepatitis C. She even suggests that oncologists do a full hepatitis panel on their patients with elevated liver enzymes. It is important to note that there is hope for those dually diagnosed with breast cancer and Hepatitis C. When extra cautionary measures are taken, these individuals have the potential for regaining their health.
With so many people being diagnosed with breast cancer and Hepatitis C, the primary item needing attention in such cases is the integration between the fields of hepatology and oncology. According to Morrow, “I think what we need to do is to cooperate with hepatologists to see if we can act at the onset and see if we can reduce the type of risks that we're seeing in these patients’ therapy.” Although modern medicine is often fragmented into specialties, this research urges healthcare workers to work together in search of their common goal – patient wellness.
References:
P.K.H. Morrow, et al., Clinical outcomes of breast cancer patients with hepatitis C: A case series, Journal of Clinical Oncology, June 2005.
http://jama.ama-assn.org, Hepatitis C Prevalence, Tracy Hampton, PhD, Journal of the American Medical Association, June 2006.
www.cancer.org, What is Breast Cancer in Men?, American Cancer Society, Inc., 2007.
www.chemocare.com, Chemotherapy Terms, The Cleveland Clinic Foundation, 2007.
www.docguide.com, Breast Cancer Patients With Hepatitis C Require Surveillance to Avoid Poor Outcomes, P/S/L Consulting Group Inc., September 2007.
www.emedicine.com, Breast Cancer, Mammography, Nagwa Dongola, MD, FRCR, WebMD, 2007.
www.mdanderson.org, Who We Are, The University of Texas M. D. Anderson Cancer Center, 2007.
www.medpagetoday.com, ASCO Breast: Hepatitis C Impacts Breast Cancer Treatment, Crystal Phend, MedPage Today, LLC, September 2007.
www.websters-online-dictionary.org, Myelosuppression, Philip M. Parker, INSEAD, 2007.
www.menstuff.org, Breast Cancer in Men, Gordon Clay, 2007.
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