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According to a recent article, the number of adults seeking liver
transplants for hepatitis C infection will skyrocket in the next 20
years [11]. About 10,000 Americans die from this disease each year.
Deaths are estimated to increase because of the increasing risk of
infection, and the resulting cirrhosis, portal hypertension,
thrombocytopenia, bleeding from varices, and liver cancer. Five years
ago, 20% of these hepatitis C patients were candidates for liver
transplantation and today the number has increased to about 50%.
An estimated 4 million Americans are infected with hepatitis C and
many of them are being evaluated for liver transplant surgery. This
expensive process costs roughly $300,000 during the first 3 months, and
can be painful and incapacitating. Add to this the thousands of dollars
for anti-rejection drugs and the costs of more frequent visits to
health care facilities. Of course some people do require liver
transplant surgery, however, the author believes that in many cases, an
effective alternative therapy exists.
Often, patients with progressive hepatitis C, who seeks a more
conservative treatment, prior to surgery present to our facility. These
patients are treated with a program that includes and combines
alpha-lipoic acid, silymarin and selenium. Most patients recover
quickly, however, a few find it difficult to follow a healthy
nutritional and lifestyle program, or their condition is so far
advanced that they go on to liver transplant surgery. In this paper,
the case histories of 3 patients are presented.
ABSTRACT
Background:
There has been an increase in the number of adults
seeking liver transplantation for hepatitis C in the last few years and
the count is going up rapidly. There is no reliable and effective
therapy for chronic hepatitis C since interferon and antivirals work no
more than 30% of the time, and liver transplant surgery is uncertain
and tentative over the long run. This is because, ultimately, residual
hepatitis C viremia infects the new liver. Furthermore, liver
transplantation can be painful, disabling and extremely costly.
Treatment Program: The author describes a low cost and efficacious
treatment program in 3 patients with cirrhosis, portal hypertension and
esophageal varies secondary to chronic hepatitis C infection. This
effective and conservative regimen combines 3 potent antioxidants
(alpha-lipoic acid [thioctic acid], silymarin, and selenium] that
possess antiviral, free radical quenching and immune boosting
qualities.
Conclusion:
There are no remarkably effective treatments for
chronic hepatitis C in general use, Interferon and antiviral have less
than a 30% response rate and because of the residual viremia, a newly
transplanted liver usually becomes infected again.
The triple
antioxidant combination of alpha-lipoic acid, silymarin and selenium
was chosen for a conservative treatment of hepatitis C because these
substances protect the liver from free radical damage, increase the
levels of other fundamental antioxidants, and interfere with viral
proliferation.
The 3 patients presented in this paper followed the
tripleantioxidant program and recovered quickly and their laboratory
values remarkably improved. Furthermore, liver transplantation was
avoided and the patients are back at work, carrying out their normal
activities, and feeling health.
The author offers a more conservative
approach to the treatment of hepatitis C, that is exceedingly less
expensive. One year of the triple antioxidant therapy described in this
paper costs less than $2,000, as compared to more than $300,000 a year
of liver transplant surgery. It appears reasonable, that prior to liver
transplant surgery evaluation, or during the transplant evaluation
process, the conservative triple antioxidant treatment approach should
be considered. If there is a significant betterment in the patient’s
condition, liver transplant surgery may be avoided.
Key Words: Hepatitis C – treatment – antioxidant – alpha lipoic acid – thioctic acid – silymarin – selenium
Background:
More than 20 years ago, when the author was in medical
and pathology training at 2 hospitals in Cleveland, Ohio, he was
assigned to 6 critical patients who were suffering from acute hepatic
necrosis secondary to hepatotoxic mushroom poisoning. He ordered
thiocgic acid (alpha-lipoic acid, ALA) from the National Institutes of
Health and injected this antioxidant drug into the patients. In spite
of their highly threatening condition the patients, as measured by
laboratory values and clinical parameters, recovered quickly. Dr. Fred
Bartter (then Chief of Hypertension and Endocrinology at the NIH) and
the author were astounded by their recoveries and went on to treat many
more mushroom poisoning patients. Over the years, the author continued
to treat additional patients with other medial conditions using ALA,
and observed similar results. The author has recently added silymarin
and selenium to the regimen. In this paper he will discuss the use to
this triple antioxidant regimen in the management of 3 chronic
hepatitis c patients.
Patients and Method:
The 3 basic antioxidants there were used in
this report are alpha-lipoic acid (thioctic acid), silymarin and
selenium (selenomethionine). The alpha-lipoic acid product was
manufactured by Asta Medica at Frankfurt Am Main, Germany. The
silymarin was a product distributed by NOW Foods of Bloomingdale,
Illinois, and the selenium was encapsulated by Metabolic Maintenance
Products Inc., of Sisters, Oregon.
The 3 patients were selected at random from a group of
approximately 50 chronic hepatitis C charts at the Integrative Medical
Center of New Mexico in Las Cruces. Each patient was maintained on a
dose of 600 mg. Of alpha-lipoic acid a day in 2 divided portions of 300
mg. each. The silymarin dose was 900 mg. Per day in 3 divided portions
of 300 mg. The selenomethiomine dose was 400 mcg in 2 divided portions
of 200 mcg.
Because alpha-lipoic acid depletes some of the B vitamins, the
patients were prescribed 2 B-100 capsules a day. In addition, each
patient also took between 1,000 and 6,000 mg. Of vitamin C, 400 IU of
vitamin E, and a mineral supplement. The patients were also requested
to eat a daily diet that included at least 6 servings of fresh
vegetables and fruits, only 4 oz or less of meat per meal, and 8
glasses of fresh water.
It was also suggested that the patients reduce their stress levels,
and take part in an exercise program that included at least a 1-mile
walk 3 times a week. The patients followed the nutritional supplement
program carefully, however, it is not clearly known whether the other
regimens were correctly followed.
CASE STUDIES:
PATIENT 1:
Mrs. M.P. is a 57-year-old woman who acquired hepatitis C after a
blood transfusion during surgery about 10 years ago. She did not eat a
nutritious diet and did not live a very healthy lifestyle at that time.
About 5 years ago, she became very fatigues and nauseous, and was
diagnosed with non-A, non-B hepatitis. She was treated with
conventional therapies and continued to degenerate into a poorer state
of health. About 3 years ago she was diagnosed with chronic hepatitis
C. cirrhosis, portal hypertension. esophageal varcies, and
thrombocytopenis, and treated with steroids and interferon. She did not
improve. Her AFP (alpha-fetoprotein) level become elevated (16.1) and a
mass was located in her liver. Mrs. M.P. was told that the mass was
probably cancer and that there was no hope.
Mrs. M.P. presented at our office last year appearing fatigued,
weak, pale, and her abdomen was grossly enlarged. The abdominal
distention was due to ascites. She was administered oral furosaminde
(40 mg) and potassium chloride (10 meq) with a balanced die and
wholesome lifestyle. She lost almost 50 lb of fluid in 1 month. Mrs.
M.P. was treated with 600 mg. Of oral apha-lipoic acid in 2 divided
doses (300 mg each), 900 mg of silymarin in 3 divided doses (300 mg
each) and 400 mg of selenium a day. A premium B complex vitamin was
added to her regimen because alpha-lipoic acid depletes the body of
thiamin, biotin and other B vitamins. Adequate amounts of vitamin C
(2,000 mg), vitamin E (800 IU), Coenzyme Q10 (300 mg), and basic
mineral supplements were also prescribed. Figures 1 and 2 track the
favorable changes in her ALT levels and her AFP levels. Today, Mrs.
M.P. is working 8 hours a day, feels healthy, looks good, and is not
tired. She is free of the signs and symptoms of serious chronic
hepatitis C infection.
PATIENT 2
Mrs. P.P. is a 49-year-old woman who was infected with hepatitis C
following a blood transfusion prior to trauma surgery more than 10
years ago. During surgery, her spleen was excised because it was
lacerated.
About 3 years ago, a liver biopsy was performed that showed
moderate cirrhosis with active inflammation. As a result of this
pathology, Mrs. P.P. went on to develop portal hypertension with
esophageal varices. She never acquired thrombocytopenia because of the
spenectomy, and did not show an elevated AFG. Mrs. P.P. was treated
with interferon therapy without any satisfactory results. She was told
that her condition was hopeless and that a liver transplant was her
only option. Her health continued to decline and she presented at our
office with fatigue, anxiety, and insomnia.
Mrs. P.P. was prescribed 600 mg. Of alpha-lipoic acid each day in 2
divided doses (300 mg each). To that, was added silymarin (900 mg/day)
and selenium (400 ug/day). To combat the anxiety and insomnia, 0.5 of
aprazolam was prescribed, as needed at bedtime. Mrs. P.P. was put on a
balanced health and lifestyle program, and within 7 months regained her
health. Figure 3 to 5 trace the favorable changes in her ALT levels,
viral load and platelet levels. She is doing very well today and is
working at an arduous job and playing at sports without any fatigue or
other symptoms of serious disease.
PATIENT 3
Mrs. L.M. is a 35-year-old mother of 3 children who developed
hepatitis C secondary to a blood transfusion during the birth of her
baby girl 15 years ago. Three years ago she became ill and was
diagnosed with cirrhosis of the liver, portal hypertension, and
esophageal varcies. As a result of th4 portal hypertension, she
developed splenomegaly and thrombcytopenia. Mrs. L.M.’s hepatologist
sent here to the university hospital for liver transplant evaluation.
When she presented to our office, she was anxious, tired, and pale, and
complained of constant pain in the regions of her liver and spleen.
Mrs. l.’s fasting blood sugars were in the 300-mg/dc range. She did not
have hyperglycemia prior to the hepatitis C infection. Mrs. L.M.
decided that prior to the liver transplant surgery, she wanted to
investigate a more conservative treatment regimen.
Mrs. L.M. was prescribed alpha-lipoic acid (600 mg./day), silymarin
(900 mg./day) and selenium (400 ug) per day with other supportive
supplements. She was encouraged to follow a health lifestyle program
with a 2,000 calorie diabetes diet. Within 2 weeks she began to feel
much better and recovered quickly. Her blood sugar fell into the normal
range and the pain in her liver and spleen ended. She became energized
and was able to do her normal work as a housewife. She returned to
college the next semester earning a 3.8 grade point average (A).
Figures 6 and 7 trace her favorable progress.
DISCUSSION
ALPHA-LIPOIC ACID
Alpha-lipoic acid (ALA) is a small organic molecule with a
disultide bond. It is a superb antioxidant that is soluble in both
water and fat. ALA is an important coenzyme for the production of
acetyl coenzyme A. Dihydorlipoic acid (DHLA), it’s reduced form, is an
electron donor that recycles other fundamental antioxidants (vitamin C,
vitamin E, and glutathione). ALA and DHJLA are superb free radical
scavenger themselves because they neutralize peroxyle radicals [36],
hydroxyl radicals [39] and singlet oxygen [38].
ALA is also a metal chelator that removes mercury from tissues
[17], prevents calcium oxalate crystals (stones) from forming in the
kidneys [21, chelates copper [28], and removes arsenic [18].
Lately, there has been a great explosion in ALA research. The
lipoic acid/dihydrolipoic acid redox couple inhibits viral replication
by stabilizing the NFK beta transcription factor [4], blocks the
development of cataracts [24], protects the kidneys form aminoglycoside
damage [35], insulates the pancreatic islet cells form inflammatory
assault [7], inhibits thymocyte apoptosis [8], and stimulates the
production of helper T cells [15]. In addition, the toxic side effects
of cancer chemotherapy can be attenuated with the use of ALA [5] and it
protects bone marrow from free radical damage secondary to ionizing
radiation. [33].
Numerous other studies show that ALA is useful for the treatment of
diabetes mellitus and syndrome X because it increased cellular glucose
utilization [19]. And significantly reduces insulin resistance [12,20].
Diabetic neuropathy originates from a decrease in blood flow to
various organs. This results in an accumulation of free radicals that
can destroy nerve function. In one study, ALA brought about a
significant reduction of neuropathic symptoms in 23 patients [46]. This
was accomplished by abolishing the products of lipid peroxidation and
increasing the entrance of glucose into the cell [27].
Due to ALA’s lipophilic characteristics, it can cross the
blood-brain barrier quite easily and can scavenge free radical toxins
in the central nervous system. Both ALA and DHLA protect animals from
neuronal death following laboratory-induced cerebral ischemia and
reperfusion experiments [9,16,32]. This effect is explained by the fact
the ALA greatly increased glutathione levels in nervous tissue, thus
protecting the nerves from the toxic products of oxidation.
For many years, ALA was used as a treatment for liver disease. As
of yet, however, there are not many papers on this subject, and some
studies used entirely sub-therapeutic dose [25].
Ethyl alcohol (ETOH) damages the liver by several mechanisms that
ultimately lead to the proliferation of innumerable free radicals.
These toxins damage the cell membranes by lipid peroxidation. It has
been reported the ALA lowers the levels of ETOH metabolic breakdown
products, and in consideration of this ALA may be an effective
treatment for alcohol induced hepatitis, early cirrhosis, and alcoholic
coma [23, 37].
In the late 1960’s and 1970’s, there were several studies
describing the successful treatment of hepatotoxic mushroom poisoning
with intravenous ALA [22, 47]. National Institutes of Health studies
reported the survival of 73 out of 79 seriously poisoned patients [3,
6]. In American, interest in the use of ALA for hepatotoxic mushroom
poisoning, and liver disease in general, was in the main lost, because
of the growing fascination with liver transplantation as a proposed
"standard of care" treatment for serious liver disease.
SILYMARIN
Silymarin is the mixed extract of the milk thistle plant (sylibum
marianum) and has been used for hundreds of years as a treatment for
liver disease. In the late 1960’s and 1970’s it was extensively used
for serious hepatotoxic mushroom poisoning with excellent results [43].
It has been demonstrated to be a proficient antioxidant, protecting the
liver by neutralizing dangerous hydroxyl radicals, superoxide ions and
hypochloric acid. In this way silymarin neutralized the toxins that
destroy the cellular membrane systems and the hepatocyte’s genetic
material [10, 26, 41]. Silymarin, like ALA, increases cellular
glutathione levels and decreases tumor promoter activity {1, 30].
Human viral hepatitis studies with silymarin demonstrate quicker
normalization of liver enzymes, expeditious reduction of bilirubin
levels, and shorter hospital stays [31]. In addition, silymarin has
been shown to be an effective antidote for toluene and xylene toxicity,
and drug overdoes [14, 29, 40]. Alcoholic and other chronic liver
disease patients lowered their liver enzymes, decreased their levels of
procollagen III, and improved the histology of their livers with daily
oral administration of silymarin [2,13, 34]. Taking this intelligent
reasoning into account, silymarin offers another effective treatment
choice for serious liver disease.
SELENIUM
Selenium (Se) is an essential metal that is required for normal
antioxidant metabolism, reproduction and thyroid function. It is also
an important coenzyme for the glutathione peroxidase detoxification
system. Because of this, selenium neutralized peroxides that
proliferate under oxidate stress and consequently protects cell
membranes from free radical damage.
Selenium often combines with amino acids and forms selenoproteins.
Viruses might benefit from being directly involved in this
selenoprotein encoding process by monitoring selenium levels in the
cell. Consequently, this viral behavior could act as a barometer for
increasing or decreasing viral reproduction. If cellular selenoprotein
levels fall, the virus might become more active and produce more
viruses that attack new cells. If selenoprotein levels rise, the virus
may remain in a dormant state for longer periods of time or remain
permanently dormant.
Research papers have reported that RNA viruses, including hepatitis
C virus, encode selenium-dependent glutathione peroxidase genes. In
view of this concept, it is entirely possible that a specific viral
gene could generate a selenium shortage in the host. And in this way, a
selenium deficiency could stimulate viral proliferation and thus
promote the progression of hepatitis C. To continue, in that case, the
addition of selenium might act as a "birth control pill" for the virus,
and thus show down it’s reproduction mechanisms. According to several
investigators this could give the immune system a chance to control the
hepatitis C or HIV disease process [42,45].
CONCLUSION
There are no remarkably effective treatments for chronic hepatitis
C in general use. Interferon and antivirals have less than a 30%
response rate and liver transplantation is uncertain and tentative.
This is partially due to the residual viremia; the newly transplanted
liver ultimately becomes infected again [44].
The triple antioxidant combination of alpha-lipoid acid, silymarin
and selenium were chosen for a conservative treatment of hepatitis C
because these substances protect the liver from free radical damage,
increase the levels of other fundamental antioxidants and interfere
with virus proliferation. The 3 patients presented in this paper
followed the triple antioxidant program and recovered quickly form this
potentially devastating viral infection. Furthermore, liver
transplantation can be painful, disabling, and extremely costly.
The author offers a more conservative approach to the treatment of
hepatitis C that is exceedingly less expensive. One year of the triple
antioxidant therapy described in this paper costs less than $2,000, as
compared to more than $300,000 a year for liver transplant surgery. It
appears reasonable, that prior to liver transplant surgery evaluation,
or during the transplant evaluation process, this conservative triple
antioxidant treatment approach should be considered. If there is a
significant betterment in the patient’s condition, liver transplant
surgery may be avoided.
Dr. Berkson’s Biography:
Undergraduate and Graduate Education:
BS: Roosevelt University, Chicago (Biology/chemistry)
MD: Autonomous University System, Mexico
MS, Ph.D. University of Illinois, Urbana (Biological Sciences)
Medical Post Graduate Training:
Internal Medicine Resident (St. Lukes Hopsital, Western Reserve Univ. 77-70 )
Pathology resident (Mt. Sinai Hospital, Western Reserve Univ. 78-79
Mini-Residency Obstetrics (University of New Mexico Hospital 1980)
Certification Hypnotherapy ASCH
ACLS Certification
Academic Positions and Responsibilities:
Assist. Professor (Biology, Mycology) Rutgers University 68-72
Assoc, Professor (Biology, Microbiology) Chicago State University 72-74
Visiting Professor Max Planck Institute, Heidelberg 78
Adjunct Professor (applies Biology, EPPWS) New Mexico State Univ., Present
Consultant Mushroom Poisoning (ALA) Center for Disease Control, Atlanta
Toxicology Consultant, New Mexico Poison Control Center
Principal Investigator, FDA, IV Thiocatic Acid (Alpha-Lipoic Acid)
Member, New Mexico Medical/Legal Panel
Member, El Paso Fund Alternative Medicine Committee
Numerous Other Visiting Professorships and Research Associate Positions
Medical Practices
Integrative Medical Center of New Mexico 1996 – Present
Attending Physician, White Sands Missile Range, New Mexico 1989-1997
Emergency room Physician, New Mexico 1979-1988
Private rural family practice, Hobbs & Lovington, New Mexico 1980-1986
Author: "Alpha Lipoic Acid Breakthroughs"
[As published in "Medizinishche Klinik", a German medical journal.]
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