Research & Treatment News
July 23, 2010
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The number of reasons whey protein can help someone with chronic, viral hepatitis may surprise you.
by Nicole Cutler, L.Ac.
Often added to milkshakes or blended drinks, whey protein can usually be found on store shelves in sections dedicated to building muscle mass. As such, whey protein has long been an ingredient consumed by bodybuilders and serious athletes. Despite whey protein's popularity with the muscle-pumping crowd, it has several characteristics that also make it an ideal staple for those living with chronic, viral hepatitis.
About Chronic, Viral Hepatitis
Chronic, viral hepatitis describes liver disease that is usually caused by the Hepatitis B virus or Hepatitis C virus. Hepatitis A usually does not progress to a chronic problem, and the other hepatitis viruses are much less common. Hepatitis B and C have the potential to be cured with modern medicine. However, a significant portion of those infected are unable to clear the virus from their liver with the currently available medications. These individuals are advised to make an array of lifestyle changes to protect their liver from damage and prevent this disease from progressing to a more advanced stage.
About Whey
The protein in milk is whey protein. Whey is the liquid that separates from curd during the production of cheese. When the liquid dries into powdered whey, the nutrients become concentrated, and it can be packaged and used in that form.
While predominantly composed of protein, whey is a complex substance that also contains lactose, fat and minerals. Each with its own unique properties, whey's protein content is a conglomeration of smaller components (called sub-fractions). A handful of whey's sub-fractions include:
· Beta-lactoglobulin - Provides an excellent source of essential and branched chain amino acids (BCAAs). While BCAAs help prevent muscle breakdown and spare glycogen during exercise, they also are helpful for those with advanced liver disease. Although the reason is unclear, experts understand that people with cirrhosis of the liver may live longer, improve their liver function, have fewer hospital admissions and have an increased quality of life by taking supplemental BCAAs.
· Alpha-lactalbumin - The primary protein found in human breast milk, alpha-lactalbumin is high in tryptophan, an essential amino acid. Potential benefits of this protein include sleep regulation and mood improvement under stress.
· Immunoglobulins (IgGs) - Provides immunity-enhancing benefits, a coveted function for those with chronic hepatitis.
· Glycomacropeptides - Helps control and inhibit the formation of dental plaque and dental cavities - a common problem in those with chronic hepatitis.
· Lysozyme - Contains immunity-enhancing properties, a coveted function for those with chronic hepatitis.
· Lactoferrin - May help to reduce inflammation, an invaluable characteristic for those whose liver easily becomes inflamed.
Whey and Glutathione
While some of whey protein's sub-fractions can help someone with hepatitis remain healthy, whey's promotion of glutathione delivers a specific benefit to those with liver disease. Whey protein contains high levels of the amino acid cysteine, which is needed for the body to produce glutathione.
Glutathione is an antioxidant found in all tissues protecting against potential damage from wastes and toxins. Clinical studies have demonstrated that the level of glutathione is significantly depressed in many people with Hepatitis C. Experts also recognize that glutathione deficiency is an important factor contributing to liver damage. Thus, supplements that boost the body's production of glutathione indirectly benefit people with chronic hepatitis.
Japanese Study
A Japanese animal study published in the May 2006 edition of Bioscience, Biotechnology and Biochemistry, investigated the effect of whey protein on the liver. Although their subjects were not human, the researchers found that rats on a whey-containing diet demonstrated the following:
· Lower liver enzyme levels indicating liver damage (ALT and AST)
· Lower indicators of liver fibrosis (hyaluronic acid)
· Lower levels of traditional hepatitis markers (lactate dehydrogenase and bilirubin)
Based on the results, the authors concluded that supplementing with whey protein can help prevent the development of hepatitis and portal fibrosis.
Too Much Whey
As a dietary supplement, whey protein is generally considered to be safe. However, the sentiment that you can have too much of a good thing applies to whey protein. Extremely high doses of whey protein supplements could overload the liver and cause damage. To avoid this possibility, experts suggest restricting intake of whey protein to less than 30 grams at one time.
While whey protein is certainly no cure, it does show great potential as a dietary supplement for those with liver disease. Because it supports the immune system, helps the body handle stress, eases inflammation and promotes glutathione production, whey protein should be considered by anyone who is managing chronic, viral hepatitis.
References:
http://articles.mercola.com/sites/articles/archive/2009/12/08/Top-12-Foods-for-Healthy-Immune-Response.aspx, Top 12 Foods for Healthy Immune Response, Dr. Mercola, Retrieved December 11, 2009, Dr. Joseph Mercola, 2009.
http://bastyrcenter.org/content/view/787/, Branched-Chain Amino Acids Treat Cirrhosis, Retrieved December 13, 2009, Bastyr Center for Natural Health, 2009.
http://health.learninginfo.org/liver-health.htm, Liver Health: How to Care for Your Liver, Retrieved December 13, 2009, learninginfo.org, 2009.
http://www.fitfaq.com/whey-protein.html, The Whey It Is, William D. Brink, Retrieved December 12, 2009, fitFAQ.com, 2009.
http://www.hepatitis-central.com/mt/archives/2007/07/hcv_and_the_bod.html, HCV and the Body's Most Important Antioxidant, Nicole Cutler, L.Ac., Natural Wellness, 2009.
http://www.jstage.jst.go.jp/article/bbb/70/5/70_1281/_article, Hepatoprotective Effects of Whey Protein on D-Galactosamine-Induced Hepatitis and Liver Fibrosis in Rats, Hisae Kume, et al, Bioscience, Biotechnology and Biochemistry, May 2006.
http://www.wheyoflife.org/articles/Aug_ARA_Article.pdf, Nourish Your Body The Healthy "Whey", Retrieved December 13, 2009, Whey Protein Institute, 2009.
http://www.wheyoflife.org/faq.cfm#1, Whey Protein FAQ's, Retrieved December 13, 2009, Whey Protein Institute, 2009.
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July 22, 2010
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Although they have very similar sounding names, learn why qualitative Hepatitis C tests and quantitative Hepatitis C tests have some important differences.
by Nicole Cutler, L.Ac.
To everyone except physicians who treat hepatitis and fastidious researchers, the range of tests that someone with the Hepatitis C virus (HCV) endures can be dizzying. Unless you are lucky enough to have a hepatologist sit down and explain the differences and implications of each blood draw, it is easy to be misled by the barrage of lab test results. Especially important for individuals who are currently enrolled in or who have finished HCV antiviral therapy, understanding viral load tests can bring clarification to an otherwise confusing lab result.
Hepatitis C RNA tests are tools clinicians use to confirm a diagnosis and guide treatment. The challenge in discerning between the kinds of HCV tests likely lies in the similar sounding words to describe the tests: qualitative and quantitative. Even the most seasoned healthcare practitioners frequently flub these categories. Below you will find a brief description of the two HCV RNA (the genetic material for Hepatitis C) tests and a helpful mnemonic technique to differentiate between the two:
· Qualitative Test - This kind of test detects the presence or absence of HCV RNA. It is reported as either detected (positive) or not detected (negative). The qualitative test is useful to confirm an active HCV infection. The L in qualitative can be equated to a label - as in it is used to label someone as having or not having the virus.
· Quantitative Test - The quantitative test measures the actual number of copies of HCV RNA in the blood. Commonly referred to as the viral load, a quantitative test is typically used to monitor how a person is responding to HCV treatment. The N in quantitative can be equated to a number - as in it is used to report the number of HCV viral particles present.
More About Qualitative Testing
To report whether or not HCV is present in the blood, the qualitative HCV RNA tests use either a process called polymerase chain reaction (PCR) or a process called transcription-mediated amplification (TMA). If such a test is positive, or detected, then chronic Hepatitis C infection is confirmed. Although it does not compute a number, the qualitative test is more accurate than the quantitative test because it can detect very low levels of the virus.
More About Quantitative Testing
Quantitative tests that measure the actual level of Hepatitis C virus in the blood may use the processes of PCR, TMA or signal amplification (branched DNA). These viral load tests compute the number of HCV RNA particles present, and are expressed in either international units per liter (IU/L) or copies per milliliter (mL). The quantitative HCV RNA test is used to monitor individuals who undergo antiviral treatment - prior to beginning therapy, during therapy and upon its completion.
Additional Viral Load Test Facts
The following seven facts about Hepatitis C viral load tests help deepen our understanding of the testing process.
1. If someone has a positive qualitative test but a quantitative test showing no detectable virus, then that person has a very low level of the virus in his or her blood.
2. If someone has a negative qualitative test following antiviral treatment, they are clear of the Hepatitis C virus.
3. In order to obtain a sustained viral response (considered a successful conclusion to HCV treatment), a qualitative test should be negative following the completion of treatment and then again six months later. Most physicians will use a qualitative test (as opposed to a quantitative test) to confirm a sustained viral response.
4. Viral load as measured by a quantitative test does not correlate with the severity of Hepatitis C.
5. The viral load measurement does not correlate with the severity of liver disease. Only a liver biopsy (or equivalent method) can determine the health of the liver.
6. Because HCV viral load will normally fluctuate, repeated viral load tests are only indicated for those on or considering antiviral treatment.
7. If a quantitative HCV RNA result is reported as <615 IU/L, then the test is unable to measure any of the virus. Thus, such a result should be followed by a qualitative test.
Upon reviewing the differences between quantitative and qualitative Hepatitis C tests, there will be a little less mystery in deciphering lab results. Although HCV RNA quantitative tests are mostly used to gauge how someone progresses with antiviral therapy, the qualitative test is the only way to know for sure if the Hepatitis C virus is still taking up residence in your body.
References:
http://digestive.niddk.nih.gov/ddiseases/pubs/chronichepc/#c, Chronic Hepatitis C: Current Disease Management, Retrieved July 14, 2010, National Digestive Diseases Information Clearinghouse, 2010.
http://hepatitis.about.com/od/diagnosis/f/HCVRNATest.htm, What are HCV RNA Tests?, Charles Daniel, Retrieved July 15, 2010, about.com, 2010.
http://www.hcvadvocate.org/hcsp/articles/Bernstein-1.html, The Importance of Laboratory Test Results in Hepatitis C Infection, David Bernstein, MD, FACP, FACG, Retrieved July 15, 2010, Hepatitis C Support Project, 2010.
http://www.hepatitis.va.gov/vahep?page=diag-tests-03-02, Hepatitis C RNA Qualitative Testing, Retrieved July 15, 2010, US Department of Veteran Affairs, 2010.
http://www.questdiagnostics.com/hcp/intguide/jsp/showintguidepage.jsp?fn=TG_HCV_MolecularTesting.htm, Molecular Testing in the Management of Hepatitis C Virus Infection, Retrieved July 15, 2010, Quest Diagnostics, 2010.
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July 20, 2010
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Find out about a molecular biology discovery that has led to a new understanding about the general health decline that can follow a liver transplant.
by Nicole Cutler, L.Ac.
By evaluating one of the cellular components of senescence (the period of decline in health and function associated with aging), British researchers have identified a reason that liver transplant recipients are particularly susceptible to degenerating health. Since the Hepatitis C virus (HCV) is the most likely reason for a liver transplant in the United States, those with advanced HCV are more vulnerable to this characteristic of aging. Although the medical community is just beginning to unravel some of the biological factors involved in senescence, those with HCV who need a liver transplant can capitalize on the knowledge garnered thus far.
Telomeres
Three American scientists were awarded the 2009 Nobel Prize for Physiology and Medicine for their discovery about aging. Involving how chromosomes are copied during cellular division, these scientists identified telomere length as a predictor of health and longevity.
Crucial for cellular division, telomeres are protective DNA-protein complexes positioned at the tips of chromosomes:
· When cells divide, the exact sequence of DNA must be transcribed from the chromosomes of the parent cell to create chromosomes for the new cell.
· A piece of the telomere is clipped off and donated to the DNA sequence at the end of the chromosome so that the copying is complete and accurate.
· Most cells normally divide about 50-70 times, their telomeres getting progressively shorter until the cells lose their ability to divide, sustain genetic damage (which can cause cancer) or die.
Telomeres and Liver Transplant Recipients
On the heels of recognizing shortened telomere length as a hindrance to health and longevity, William Gelson from the University of Cambridge and colleagues investigated whether liver transplant recipients demonstrated this unwanted feature of senescence in immune cells.
As published in the May 2010 issue of Liver Transplantation, the British researchers found this marker of senescence to be accelerated in those with Hepatitis C who undergo liver transplants. Gelson and colleagues found that the telomeres of an important immune cell (lymphocytes) were significantly shorter in liver transplant recipients compared with control subjects. These findings suggest that besides immunosuppressive drugs used to prevent organ rejection, weakened immunity leading to complications (infections and cancers) in transplant patients may be attributable to senescence of the immune system - as identified by lymphocytes with shortened telomeres.
These findings suggest that liver transplant recipients may experience faster immune cell aging, which could help explain their increased rates of infections, cancer and other serious conditions.
Keeping Telomeres Long
While modern science is still a long time away from discovering the fountain of youth that prevents senescence, many experts believe that antioxidants represent the best defense against aging and illness.
As published in the July 2002 edition of the journal, Trends in Biochemical Sciences, researchers from the University of Newcastle found that oxidative damage is repaired less well in the DNA of the telomere than elsewhere in the chromosome. Additionally, it was determined that oxidative stress accelerates telomere loss, whereas antioxidants decelerate it.
For decades, increasing the dietary consumption of antioxidants has been considered to be a superior strategy for retaining one's youth and healthfulness. However, our new understanding of telomere length in liver transplant recipients gives those with late stage HCV infection more incentive than ever to indulge in antioxidants. Because shortened telomeres are more abundant following a liver transplant - and they foretell of a shorter life span - strategies to preserve telomere length (such as antioxidant consumption) will emerge as paramount to delay senescence in HCV liver transplant recipients.
References:
http://nobelprize.org/nobel_prizes/medicine/laureates/2009/press.html, The Nobel Prize in Physiology or Medicine 2009, Retrieved July 11, 2010, Nobel Web AB, 2010.
http://www.all-things-aging.com/2010/06/telomeres-aging-and-cancer.html, Telomeres, Aging and Cancer, Constance McCloy, PT, EdD, Retrieved July 11, 2010, All Things Aging, 2010.
http://longevity.about.com/od/whyweage/a/senescence.htm, Senescence, Healthy Aging and Longevity, Mark Stibich, PhD, Retrieved July 11, 2010, About.com, 2010.
http://www.hivandhepatitis.com/hep_c/news/2010/0709_2010_c.html, Immune Cells Show Signs of Senescence after Liver Transplantation, Liz Highleyman, Retrieved July 10, 2010 hivandhepatitis.com, 2010.
http://www.ncbi.nlm.nih.gov/pubmed/12114022, Oxidative stress shortens telomeres, von Zglinicki T, Retrieved July 11, 2010, Trends in Biochemical Sciences, July 2002.
http://www.ncbi.nlm.nih.gov/pubmed/20440767, Features of immune senescence in liver transplant recipients with established grafts, Gelson W., et al, Retrieved July 11, 2010, Liver Transplantation, May 2010.
http://www.springerlink.com/content/jw847g541l435103/, Cellular senescence, ageing and disease, D.G.A. Burton, Retrieved July 11, 2010, Age, March 2009.
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July 6, 2010
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While most of us check the time throughout the day to stay on schedule, few realize that the liver also has a timed agenda. By heeding your liver's innate clock, those with Hepatitis C can help relieve some of the extra burden on this multitasking organ.
by Nicole Cutler, L.Ac.
Chronic Hepatitis C is a worldwide problem, infecting the livers of an estimated four million people in the U.S. alone. Until a guaranteed cure is devised for Hepatitis C, those with the virus must make every effort to support their liver's health by relieving it of unnecessary tasks. While there are a variety of strategies employed to support liver health, one that is often overlooked is working with the liver's schedule.
In charge of a long list of life-sustaining functions, the liver is an extremely busy organ. A few of its crucial duties, include:
· Producing bile, which helps carry away waste and breaks down fats in the small intestine during digestion.
· Producing certain proteins for blood plasma.
· Making cholesterol and special proteins to help carry fats through the body.
· Converting excess glucose into glycogen for storage.
· Converting poisonous ammonia to urea (urea is an end product of protein metabolism and is excreted in the urine).
· Clearing the blood of drugs and other poisonous substances.
· Resisting infections by producing immune factors and removing bacteria from the bloodstream.
Not surprisingly, the liver can't accomplish all of its amazing feats simultaneously. All of the body's organs, including the liver, have periodic cycles where different functions are emphasized at different times. The liver is no different, with a cycle completing every 24 hours.
The Liver Cycle
Although scientists are just beginning to recognize the phases of the liver's cycle, the following appear to describe the hepatic clock:
· The liver synthesizes complex chemicals and processes toxins the most when the production of bile is lowest.
· Along the same lines, chemical synthesis and toxin processing is lowest while the liver's production of bile is highest.
· Because bile is needed for food processing, the liver makes a greater proportion during the day - and less at night.
· Bile production is assumed to be at its highest at 9am and lowest at 9pm.
· After 9pm, the liver switches to its other primary functions, synthesizing chemicals and processing accumulated toxins.
· The cycle begins shifting around 3am, when the liver slows chemical synthesis and readies itself for bile production.
· The liver cycle shifts again around 3pm, when chemical synthesis begins to increase and bile production decreases.
Thus, the liver is most prepared to aid digestion with its synthesis of bile between 9am and 9pm. This is important information for those with chronic Hepatitis C who want to work with - and not against their liver.
Practical Application of the Liver Clock
Although our busy lifestyles often dictate when we eat and when we sleep, those with Hepatitis C could benefit from scheduling necessities around their liver's needs. Since bile production is down late at night, eating a big meal past 9pm puts an additional strain on the liver. Thus, experts advise eating the last meal of the day long before the nine o'clock hour.
In addition, the liver's schedule of producing chemicals and detoxification (crucial for liver health) is best accomplished without additional demands. For this reason, most experts suggest retiring for the night close to 9pm whenever possible. Although this seems extremely early for many adults, those who try it report achieving a deeper and more restful sleep.
The liver's clock may not mesh with a modern, busy schedule. However, eating early and going to bed early cooperates with your liver's natural rhythm. By taking small steps to conform to your liver's cycle, those with Hepatitis C can remove the extra challenge that multitasking can place on their liver.
References:
Buhner, Stephen Harrod, Herbs for Hepatitis C and the Liver, Storey Publishing, North Adams, MA, 2000: p 18-19.
http://focus.hms.harvard.edu/2008/092608/research_briefs.shtml, Peripheral Circadian Clocks Take Center Stage in Homeostasis, Alyssa Kneller, Retrieved September 21, 2009, Focus, Harvard Medical, Dental and Public Health Schools, September 2008.
http://www.healthsystem.virginia.edu/uvahealth/adult_liver/liver.cfm, The Liver: Anatomy and Functions, Retrieved September 21, 2009, The University of Virginia, 2009.
http://www.hepatitis.org.uk/s-crina/liver-f3-main3.htm, Key Liver Functions, Retrieved September 18, 2009, hepatitis.org.uk, 2009.
Posted by Editors at 10:42 AM --- Printer-friendly version
July 1, 2010
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By making sure these four rules are practiced daily, those with Hepatitis C will benefit from the resulting improvement in their sleep.
by Nicole Cutler, L.Ac.
An estimated three quarters of those with Hepatitis C wage an ongoing battle against chronic fatigue. Although it seems ridiculously simple, getting a deep, restful, complete night's sleep is one of the most effective solutions for this fatigue. Unfortunately, obtaining said sleep is not always an easy feat.
For those with Hepatitis C, sleep disturbances typically accompany their illness. In the January 2010 Journal of Clinical Gastroenterology, S. Sockalingam and colleagues presented a review of sleep disturbances in people with Hepatitis C. They reported that up to 60 percent of patients with chronic Hepatitis C experience sleep problems. Some of the proposed mechanisms responsible for sleeping troubles in those with Hepatitis C, include:
· Depression - Troubled sleep is considered by experts to be a hallmark sign of depression. It is estimated that between 24 and 70 percent of those with chronic Hepatitis C experience a major depressive disorder.
· Side effect of interferon/ribavirin treatment - Up to 30 percent of interferon-treated Hepatitis C patients has newly diagnosed sleep disturbances.
· Cirrhosis - For those with an advanced case of Hepatitis C, cirrhosis typically interferes with the sleep-wake cycle.
Sleep's Importance
Variations on sleeplessness include problems falling asleep, maintaining sleep or experiencing non-restorative sleep. Because sleep rejuvenates the psyche and immune system, sleeplessness affects energy level, mood and overall health. The result of poor sleep is fatigue, which always perpetuates chronic illness. Long-term sleep deprivation is practically guaranteed to worsen the severity of chronic Hepatitis C.
A good night's sleep is more important to the immune system's response to Hepatitis C than most people realize. The immune system is activated during the deepest stage of sleep to fight disease. This is why people tend to sleep longer when they're sick. Loss of sleep, even for a few short hours during the night, can prompt one's immune system to turn against healthy tissue and organs.
As published in a September 2008 issue of Biological Psychiatry, California researchers reported that losing sleep for even part of one night could trigger the key cellular pathway that produces tissue-damaging inflammation. Obviously, inviting such inflammation in the face of the Hepatitis C virus is a surefire way to fan the flames of liver damage.
Four Sleep Tips
Those with Hepatitis C need deep, restful sleep to maintain their health. Thus, the following tips should be regarded as a strict set of rules - rather than just mere suggestions:
1. Coffee Cut-Off - While several studies have demonstrated coffee's benefits to people with Hepatitis C, it should not be consumed after 4pm; restricting caffeine intake to the morning hours is even better. Even if you can fall asleep easily after an evening espresso, your body will not get the same kind of deep, restful sleep with caffeine circulating in your system.
2. Take Control of Your Sleep/Wake Cycle - You don't need to be an infant to benefit from an established bedtime. A stringent routine of retiring and rising at the same time every day can influence the body's sleep hormones to normalize.
3. Modify Your Environment - Coinciding with the absence of activity and light, people naturally sleep at nighttime. Because we are designed to slumber during the darkest, quietest part of the day, our sleep environment should reflect that, with sounds minimized, lights low and the television (and other illuminated and noisy electronics) turned off.
4. Relax Before Bed - It's hard to fall asleep when your mind and body are racing from an active day. Take some time to unwind before your allocated bedtime by purposefully relaxing. Some ways to do this could be meditating, taking a warm bath, drinking some herbal tea or doing some deep abdominal breathing.
While severe and/or recurring insomnia certainly warrants getting help from a physician, many people's sleep problems can be corrected by heeding the four rules described above. Individuals with Hepatitis C are especially prone to sleeping difficulties. Not surprisingly, those with this liver disease have a lot to gain from a good night's rest. Thus, cutting off coffee early in the day, setting a sleep/wake cycle, controlling the sleep environment and relaxing before bed should be considered standard practices for living healthfully with Hepatitis C.
References:
http://www.hcvadvocate.org/news/newsRev/2010/HJR-7.1.html#5, HCV and Sleep Disorders, Retrieved January 26, 2010, Hepatitis C Support Project, 2010.
http://www.hepatitis-central.com/mt/archives/2009/01/why_depression.html, Why Depression is Likely With Hepatitis C, Nicole Cutler, L.Ac., Retrieved January 29, 2010, Natural Wellness, 2010.
http://www.hepatitis-central.com/mt/archives/2009/07/back_to_basics.html, Back to Basics: Helping Your Body Fight Hepatitis C, Nicole Cutler, L.Ac., Retrieved January 29, 2010, Natural Wellness, 2010.
http://www.huffingtonpost.com/dr-michael-j-breus/sleep-hygiene-101-how-to_b_412965.html, Sleep Hygiene 101: How to Ensure a Better Night's Rest, Dr. Michael J. Breus, HuffingtonPost.com, Inc., 2010.
http://www.liverdisease.com/fatigue_hepatitis.html, Fatigue and Liver Disease/Hepatitis, Retrieved January 26, 2010, Melissa Palmer, MD, 2010.
http://www.ncbi.nlm.nih.gov/pubmed/19730115?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=2, A review of sleep disturbance in hepatitis C, Sockalingam S, et al, Retrieved January 26, 2010, Journal of Clinical Gastroenterology, January 2010.
http://www.psychologytoday.com/articles/200307/bedfellows-insomnia-and-depression, Bedfellows: Insomnia and Depression, Hara Estroff Marano, Retrieved January 29, 2010, Psychology Today, July 2003.
http://www.webmd.com/hepatitis/hepc-guide/managing-hepatitis-c, Managing Hepatitis C, Retrieved January 26, 2010, WebMD, LLC, 2010.
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