Frequently Asked Questions

Hepatitis C is not that contagious. Blood to blood transmission is the only way to contract the virus. In addition, it is not spread from mother to child at birth very easily.

According to the Centers for Disease Control (www.cdc.gov), studies regarding the transmission of Hepatitis C through sexual contact (whether it is genital, oral or anal) show that body fluids such as saliva, semen or urine must contain traces of infected blood for contamination to take place. If there are breaks in the skin (or lining of the mouth vagina or anus) Hepatitis C has the potential to be transmitted through intimate contact where blood from an infected individual crosses into the bloodstream of the non-infected person.

Hepatitis C individuals in long-term monogamous relationships rarely transmit the virus to their partners. Around 2% of sexual partners of Hepatitis C infected people test positive for Hepatitis. But, it is unknown whether these people contracted the virus from their partners during intimacy, or through some other route.

Viral load is not an indicator of the severity of Hepatitis C.

There normally is fluctuation in viral load levels with Hepatitis C but there is no table or graph that demonstrates what normal fluctuation is.

We have spoken to people with viral counts totaling 30 million who feel great, and people with viral counts of 200,000 that can't get out of bed.

The only true reflections of possible liver compromise are fibrosis markers - determined either by liver biopsy or specialized blood tests.

According to the Centers for Disease Control only 20-30% of Hepatitis C patients will experience life-threatening complications due to Hepatitis C. Far more people die WITH Hepatitis C than FROM Hepatitis C.

We recommend visiting the HCV Forum on Hepatitis-Central.com at http://forums.delphiforums.com/hepatitiscen/start. You can read through threads or you can participate yourself, it's up to you.

It is our understanding that many hospitals have what is called a Charity Care Program.

To apply for this program you would complete an application, and often provide proof of income, but if you qualify, this program may cover blood tests and ultrasound up to $1000. Contact your local hospitals for more details.

Also if you are in Texas, the Texas Liver Coalition offers free hepatitis B & C testing and the PCR confirmatory test, education, literature, and resources to possibly get treated. Visit http://www.texasliver.org/ for more information.

Check with your medical provider, support groups and the internet. Local medical centers and/or medical universities may also conduct clinical trials.

Visit www.clinicaltrials.gov and type "hepatitis C" into the search field on the main page.A listing of all current clinical trials testing medications for hepatitis C will appear. To find out more information about any given trial, click on the title for expanded details, as well as the criteria for participating.

We have seen no evidence that shows that an herbal or nutritional supplement can eliminate the Hepatitis C virus. Companies that sell products that claim to 'cure Hepatitis C' are lying to you. However, many people choose to take advantage of the many benefits of alternative therapies, including supplements, to manage and support their health and well-being. Supplements offer people the ability to support and improve liver health and function, as well as the ability to manage the unwanted symptoms associated with a compromised liver. For more information about the benefits of alternative therapies, click here.

Milk thistle is the #1 researched and recommended herb for liver health. Besides being a powerful antioxidant, milk thistle protects the cells of the liver by blocking the entrance of harmful toxins and helping remove these toxins from the liver, by fighting free radicals, increasing glutathione levels, and stimulating protein synthesis in hepatic cells. Furthermore, milk thistle not only protects your liver from future damage, but also has the ability to regenerate healthy liver cells to repair past damage.

The therapeutic value of milk thistle has been confirmed by intensive chemical, pharmacological and clinical research, not only for a wide range of liver-related conditions including the ones stated above, but also for non-liver-related conditions as well. However, before taking any milk thistle supplement, research should be done into the types of milk thistle and their varying absorption rates and effectiveness. For more information on the benefits of milk thistle and what to look for, click here.

Hepatitis A and B are not as likely to become chronic infections. Hepatitis C is more likely to be a chronic condition.

No. Milk thistle has no anti-viral effects. It has been scientifically shown to protect liver cells from damage and help to regenerate liver cells. For tens of thousands of people worldwide with liver concerns this is reason enough to take milk thistle products on a daily basis.

All clinical studies in this area, both in vitro (petri dishes, test tubes, etc.) and in vivo (live subjects), have shown that milk thistle extract reduces enzyme levels by actually protecting liver cells and reducing hepatocellular necrosis (liver cell death).

In the information we located regarding the association between milk thistle and acne we found that there are no clinical studies that prove the efficacy of milk thistle as it pertains to treating acne.

Many are making associations that detoxification of the body in any way would improve overall health and possibly acne.

Milk thistle has been shown to protect the liver and promote healthy liver function, which in turn will assist in detoxification. But whether it improves acne? Maybe, but currently there is no hard evidence that it does so.

One of the inferences made is that one of the tasks of the liver is to cleanse the blood. If the liver is stagnant it will be unable to effectively cleanse the blood; this can result in skin problems ranging from acne to psoriasis, eczema, and dermatitis. Therefore the conclusion that is being made is that if the liver is not functioning properly, it could cause skin problems, thus improving the liver improves the skin.

We also found that it has been stated that milk thistle soothes and moistens the mucus membranes and soothes kidney and bladder irritations and inflammation. As a supplement that could have this effect, it can also possibly soften and moisten the skin. Thus people with skin problems such as acne have reported a clearing of impurities, healing of redness and inflammation and a dramatic softening and moistening of dry skin as well as a noticeable glow and radiance to the skin quality.

Please know that reduced enzyme levels is not a key indicator of whether milk thistle is working or not, although, for many people enzyme levels do decrease while taking milk thistle.

The real benefit of milk thistle is that it has been clinically shown to slow fibrosis, and this is not tied to enzyme levels directly. To really measure fibrosis levels your doctor would have to test for fibrosis markers.

While it is certainly pleasing to see your enzyme levels go down, please know regardless of the milk thistle product a decrease in levels is not a requirement to see that milk thistle is supporting or protecting your liver.

If, coincidentally, your enzyme levels are going up please know that milk thistle has never been shown in clinical studies to increase enzyme levels, but you may be an exception.

Milk thistle has been shown to slow the removal of certain drugs from the system, meaning they may remain in your system longer at higher levels. Researchers at the University of Pittsburgh have shown that milk thistle can slow down or reduce the activity of enzymes in the liver. This is not usually a problem unless very high levels are taken or side effects may be magnified.

We suggest speaking with your physician regarding any new medications or supplements taken along with current medications for additional information.

Blood to blood is the only way of contracting Hepatitis B.

Also, there is a vaccine for the Hepatitis B Virus.

There is no independent clinical evidence for its use in systemic viral conditions. Silver has been shown useful for topical application, such as burns, or as a topical antibiotic, but we have found no proof that ingesting it will have any effect on a virus.

There are many things that can raise liver enzymes, not the least of which being alcohol or even many over the counter medications.

Liver enzymes are introduced to the bloodstream when liver cells deteriorate. Through natural attrition a certain number of liver cells are expected to die and decompose on a daily basis. This leads to the acceptable or normal level of enzymes. If enzymes are elevated it could be an indicator that more liver cells than normal are dying on a daily basis.

Regular salt intake is what they want to avoid. For the purposes of the testing they figure one dosage will not be harmful.

Protease inhibitors are an important area of exploration for all chronic viral infections.

We don't know how you could get any on your own.

If you have minimal liver damage at this point, why not just continue to protect and support your liver naturally. Remember, according to the CDC 70-80% of people with chronic hepatitis c will not have life threatening effects.

The normal liver volume is approximately 1500 ± 100 cc in adult males and 1300 ± 100 cc in adult females. Accurate ultrasound measurement of liver volume is technically difficult.

NAC stands for N-acetyl-L-cysteine. This is an amino acid that is easily turned into the potent antioxidant, glutathione, by your body.

Glutathione is essential for normal phase two detoxification in your liver. To give you an idea of its importance - here is an example; if you were rushed to the hospital with Tylenol (acetaminophen) poisoning they would give you intravenous NAC to detoxify the acetaminophen before it destroyed a fatal amount of liver cells.

It may be important for you to know that taking NAC and nitroglycerin may cause severe headaches.

We recommend consulting with your health care provider before taking any supplements.

The negative results reported on Liv.52 in the October 1999 edition of Hepatology, Herbal Products for Liver Diseases: A Therapeutic Challenge for the New Millennium, have been extensively challenged and non-reproducible. Over 300 studies have been performed and published on Liv.52 and this appears to be the only study suggestive of Liv.52’s hepatotoxicity.

The medical director of Himalaya Drug Co., Liv.52’s manufacturer, points to poor study methodology. This research was found to be flawed in that Liv.52 has never been advocated to cure individuals with terminal liver cirrhosis, and the participants in this study were very sick and near death. These participants were not subjected to the strict protocols used in reliable studies, including restriction and/or control of alcohol use. We suggest, when evaluating the safety of an herbal product, to look at the reproducability of the study.

And as always, we recommend checking with your primary health care provider before adding any herbal product to your regime. We're confident that, based on nearly 50 years of reproducible research results, Liv.52 is a safe supplement.

It you like, you can visit http://www.himalayahealthcare.com/researchpaper/liv52.htm which provides access to over 250 research papers on Liv.52.

Traditionally, liver biopsy has been considered the "gold standard" for assessment of the state and degree of liver damage that can be a consequence of Hepatitis C.

A sonogram or CT scan of the liver can assess the liver's size and structural changes. They give some information, but are not nearly as specific as a liver biopsy.

There is an alternative to liver biopsy that carries less risk than a liver biopsy. Fibro-Test and Fibro-Spect are blood tests for determining the condition of the liver that have been approved by the FDA within the past few years. These have been tested for many years in Europe with great success. When used properly to measure certain blood chemicals, these test results have been shown to adequately correspond with biopsy results. We have heard from some that the tests are only accurate in determining State 1 or Stage 4 liver damage and not between, however the manufacturers of these test say that is not true.

Again, we suggest speaking with your health care provider if you have any questions regarding these tests.

We suggest contacting the American Holistic Medical Association at 505-292-7788 or go to their website, www.holisticmedicine.org

Hepatitis B is transmitted through blood only, not through any other bodily fluid.

As we are not medical advisors, we are unable to provide any advice regarding your health choices. This is a decision that needs to be made with your primary healthcare provider.

In our experience, the choice to begin interferon therapy is best made by weighing individual circumstances (genotype, patient health) with education (about hepatitis, interferon therapy and liver protection).

Milk thistle is not intended to treat the liver or directly affect enzyme levels. As everyone is different, some people may experience an increase, decrease or no change at all in enzyme levels.

The benefit of milk thistle is that it protects the liver from further damage by encouraging reproduction of healthy liver cells and thickening liver cell walls. Typically, this protection is evidenced by a normalization of enzyme levels, and for those who have elevated liver enzymes, they may drop.

We encourage you to speak with a physician or other healthcare practitioner to determine why your enzymes levels are low, as it could be a vitamin or mineral deficiency. Following this determination, discuss milk thistle supplementation with your physician.

Migraines and/or headaches can be the result of toxins in or thickening of the blood. Since the liver is responsible for blood purification and toxin removal, a headache arising from these circumstances can benefit from improved liver health.

Acne and/or psoriasis - One of the tasks of the liver is to cleanse the blood. If the liver is not functioning well, it will be unable to effectively cleanse the blood which can result in skin problems ranging from acne to psoriasis, eczema, and dermatitis. Therefore if liver function is impaired, it could cause skin problems, so supporting and protecting the liver can also improve the skin.

Irritable Bowel Syndrome - As the liver secretes digestive fluids via the small intestine, it has a significant role in digestive disorders. Therefore, improving liver health often improves digestive health.

Gallbladder disease (includes gallstones and bile obstruction diseases)- The gallbladder stores bile, a substance the liver produces to aid digestion. Since the gallbladder and liver share a close relationship, improving the liver's health can positively effect the gallbladder.

Biliary Atresia - This disease results in inflammation and obstruction of the ducts which carry bile from the liver into the intestine. Protecting the liver from incurring further damage can help it cope with the back-up of bile that commonly occurs with this disease.

Hemochromatosis is a condition where the body absorbs and stores too much iron. Excessive amounts of iron can lead to liver injury, so protecting the liver can minimize or eliminate damage.

Primary Biliary Cirrhosis is a chronic liver disease that causes slow, progressive destruction of bile ducts in the liver. Protecting the liver from incurring further damage can hamper the progress of this disease.

Primary Sclerosing Cholangitis is a disease in which the bile ducts inside and outside the liver become narrowed due to inflammation and scarring. Protecting the liver from incurring further damage can help prevent scarring.

Wilson's Disease is an inherited disorder of copper secretion by the liver, which can result in copper accumulation in the liver and ultimately cause liver damage. Protecting the liver can insulate it from this toxic accumulation.

Diabetes is associated with liver disease. Poorly controlled blood sugar can increase the risk of fatty liver disease. On the other hand, some types of liver disease - such as hemochromatosis - increase the risk of diabetes. Protecting the liver can reduce the risk diabetes poses to the liver.

High cholesterol - The liver makes and distributes most of the cholesterol in our body. When liver function is impaired, cholesterol levels can skyrocket. Clinical studies demonstrate that protecting and supporting the liver can lower cholesterol and triglyceride levels.

Obesity - Liver Disease is linked to obesity. Protecting the liver can enhance the body's ability to metabolize fat.

Reye's syndrome - this acute, often fatal disease (secondary to flu or other infections) can result in fat accumulation in the liver. Protecting the liver can enhance fat metabolization and maintain liver function.

Selenium is an essential mineral found in trace amounts in the body. It works as an antioxidant.

It appears that low selenium levels MAY be associated with an increased risk for liver cancer in people with Hepatitis B and/or C. Also, low selenium levels may worsen the toxic effects of alcohol on the liver.

Although its not clear, whether selenium supplementation can help prevent or treat liver damage, studies in China showed that provinces with elevated levels of liver cancer were brought to normal levels very quickly by the introduction of selenium into the inhabitant's diets.

We recommend speaking with your health care provider before taking any supplements.

The Centers for Disease Control indicate that Anti-HCV can be found in 7 out of 10 persons (70%) when symptoms begin and in about 9 out of 10 persons (90%) within 3 months after symptoms begin. However, its important to know that many people who have hepatitis C have no symptoms.

The Centers for Disease Control indicate that there are several blood tests that can be done to determine if you have been infected with HCV. Your doctor may order just one or a combination of these tests. The following are the types of tests your doctor may order and the purpose for each:

• Anti-HCV (antibody to HCV)- Anti-HCV does not tell whether the infection is new (acute), chronic (long-term) or is no longer present.
  • EIA (enzyme immunoassay) or CIA (enhanced chemiluminescence immunoassay)test is usually done first. If positive, it should be confirmed
  • RIBA (recombinant immunoblot assay)is a supplemental test used to confirm a positive EIA test
• Qualitative tests to detect presence or absence of virus (HCV RNA)
• Quantitative tests to detect amount (titer) of virus (HCV RNA)

A single positive PCR test indicates infection with HCV. A single negative test does not prove that a person is not infected; the virus may be present in the blood and just not found by PCR. In addition a person infected in the past who has recovered may have a negative test. When hepatitis C is suspected and PCR is negative, PCR should be repeated.

The Centers for Disease Control (www.cdc.gov) say Yes. A false positive test means the test looks as if it is positive, but it is really negative. This happens more often in persons who have a low risk for the disease for which they are being tested. For example, false positive anti-HCV tests happen more often in persons such as blood donors who are at low risk for hepatitis C. Therefore, it is important to confirm a positive anti-HCV test with a supplemental test as most false positive anti-HCV tests are reported as negative on supplemental testing.

Since we are not medical advisors, we suggest speaking with your physician regarding any medical questions you may have.

It's our understanding based on information provided on the Center's for Disease Control website (www.cdc.gov) that Liver Function Tests (LFT's) are blood tests that measure the level of liver enzymes. They are often called Liver Biochemical Tests because people mistakenly equate the name with the health of the liver (for example, if your ALT's are elevated, many people assume that means your liver is not functioning properly).

Liver enzymes are secreted into the blood as a normal part of liver function. When the liver is working hard or is damaged, enzyme levels in the blood are often higher than normal. Persons with HCV often have elevated liver enzyme levels. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are two enzymes that are released by the liver and are used to monitor liver health. These enzymes will fluctuate during the course of HCV infection and can serve as an indication of possible liver damage at any given time, but NOT as a definitive marker for liver disease.

Persons taking medications or drinking alcohol may have higher enzyme levels as the liver works to metabolize them (break them down). If the liver is severely damaged, levels may be low because the liver is not producing normal amounts of these enzymes. About one-third of people with hepatitis C have enzyme levels within normal range, but this does not necessarily mean the liver is healthy. Liver enzymes should be monitored every three to six months. If elevated levels continue, a liver biopsy or other blood based test may be recommended.

It's our understanding based on information provided on the Center's for Disease Control website (www.cdc.gov) that PCR amplification tests the levels of HCV RNA (the amount of antibodies), not viral load. Testing for HCV RNA is a reliable way of demonstrating that hepatitis C infection is present and is the most specific test for infection. A single positive PCR test indicates infection with HCV. A single negative test does not prove that a person is not infected. It is possible that the virus may be present in the blood yet not detected by the PCR test. Also, a person who was infected in the past but has recovered may have a negative test. When hepatitis C is suspected and PCR results are negative, PCR should be repeated.

It's our understanding based on information provided on the Center's for Disease Control website (www.cdc.gov) that PCR testing is the most sensitive virus detection test (stands for polymerase chain reaction). In the case of the hepatitis C virus, the PCR works by taking a sample of the blood and amplifying genetic material associated with the virus millions of times. PCR amplification can detect low levels of HCV RNA in serum.

PEGASYS is a medicine commonly used to treat some adults who have hepatitis C or hepatitis B, and signs of liver damage.

PEGASYS works to reduce the amount of virus in your blood, which helps your body fight the virus.

Like other alpha interferons, it can be fatal, or worsen life-threatening problems (like mental issues, problems with the immune system, heart, liver, lung, intestines, and infections). Your doctor should monitor you during regular visits.

If you show signs or symptoms of these conditions, your doctor may stop your medication. In most patients, these symptoms get better after you stop taking PEGASYS.

You should not take PEGASYS alone or with COPEGUS if:

• You are pregnant or your partner is pregnant
• You or your partner plans to get pregnant during therapy or within 6 months after treatment ends
• You are breastfeeding
• You have hepatitis caused by your immune system (autoimmune hepatitis)
• You have unstable or severe liver disease before or during treatment
• You are allergic to alpha interferons or any of the ingredients in PEGASYS and COPEGUS
• You have abnormal red blood cells (caused by conditions like sickle-cell anemia or thalassemia major)

• Risks to pregnancies
• Mental health problems (such as irritability, depression, anxiety, aggressiveness, trouble with drug addiction or overdose, thoughts about suicide, suicide attempts, suicide and thoughts about homicide)
• Blood problems (like a drop in blood cells leading to increased risk for infections, bleeding and/or heart or circulatory problems)
• Infections (which sometimes cause death)
• Lung problems (like trouble breathing, pneumonia)
• Eye problems (like blurred vision, loss of vision)
• Autoimmune problems (such as psoriasis, thyroid problems)
• Heart problems (including chest pain and, rarely, a heart attack)
• Liver problems (rarely, liver function worsens). Patients infected with both HCV and HIV can have an increased chance of liver failure during PEGASYS treatment. Change in a blood test that measures liver inflammation occurs more often in patients with hepatitis B. If you have a rise in this blood test you may need to be watched more closely with additional blood tests.

Tell your doctor immediately if you think you or your partner may be pregnant or if any of these symptoms occur.

If you need a pain reliever you may consider the following over-the-counter medications: aspirin, ibuprofen, naproxen. Avoid acetaminophen. For more information about these medications and alternatives visit http://www.hepatitis-central.com/mt/archives/2007/05/is_there_pain_r.html. Always speak with your health care provider regarding taking any supplements or medications.

We have posted many articles on these topics on the Hepatitis-Central.com website and more keep coming. To learn more about foods to avoid please visit http://www.hepatitis-central.com/searchResults.html?q=foods+to+avoid&label=all and to learn about foods you should eat visit http://www.hepatitis-central.com/searchResults.html?q=good+foods&label=all.

For those diagnosed with Hepatitis C we believe there is no acceptable level of alcohol and it should be eliminated completely.

Ascites is the presence of excess fluid in the peritoneal cavity, which is the space between the abdominal organs and the skin. As a result of this fluid buildup, the abdomen swells and distends.

While liver disease – specifically cirrhosis – is the most common cause of ascites, it can also have other causes, such as cancers, congestive heart failure or kidney failure. For more information regarding causes visit http://www.liversupport.com/ascites_causes.htm.

The treatment of ascites depends on its cause. If portal hypertension is the cause of ascites, medical management using diuretics and salt restriction is often effective in portal hypertensive patients.

If diuretics and salt restriction are not effective, in some cases, doctors may perform paracentesis to draw off the fluid from the abdomen. A few liters of fluid can be removed at a time.

In other cases where the paracentesis procedure is repeatedly required to prevent the re-accumulation of fluid, the physician may resort to other means. A transjugular intrahepatic portosystemic shunt (TIPS) may be implanted to redirect the fluid and provide relief. This procedure is performed by a vascular radiologist.

Fatty liver is a reversible condition without the potential to lead to cirrhosis. It is characterized by the deposit of fat particles (triglycerides) in the cells of the liver and can be caused by a variety of factors.

Nonalcoholic fatty liver disease (NAFLD) refers to a spectrum of liver abnormalities/disease ranging from the relatively harmless fatty liver to nonalcoholic steatohepatitis (NASH) to cirrhosis. The common factor is that all of these stages have an accumulation of fat in the liver cells.

When fatty liver is accompanied by varying degrees of inflammation and scarring (fibrosis) of the liver, it is known as nonalcoholic steatohepatitis or NASH. Unlike a fatty liver, NASH is not considered relatively harmless. Instead, NASH is considered a liver disease with the potential to cause cirrhosis, which can lead to liver failure.

The liver is involved in the metabolism of fat. This process can be disrupted by a variety of factors, including certain types of diseases, poor diet, certain medications and some toxins. When this process of fat metabolism is disrupted, the fat can accumulate in the liver in excessive amounts, thus resulting in a fatty liver.

This excess fat is stored in the liver mainly in the form of triglycerides. When this fat accumulates in the liver, but there is no inflammation or scarring, this fatty liver condition is relatively harmless.

Niacin (also known as Vitamin B3 or nicotinic acid), is a water-soluble vitamin that is used therapeutically as a cholesterol and blood lipid-lowering agent.

The side effects of niacin include flushing and gastrointestinal disturbances, and at higher-sustained doses, hepatotoxicity.

Hepatic toxicity is:

• Most common with high doses of slow-release niacin
• Less common with extended-release niacin
• Rare with immediate-release forms

Like the statin drugs, niacin helps treat high blood cholesterol levels. Similar to the statins, it can also damage the liver. Niacin is capable of causing mild elevations in blood levels of AST and ALT, jaundice, and, rarely, liver failure. Liver toxicity with niacin is dose-dependent; toxic doses usually exceed 2 grams per day. Thus, those with liver disease are at higher risk for niacin toxicity and are advised to only supplement with niacin under a physician’s close supervision.

All B vitamins:

• Help the body convert carbohydrates to glucose, which is used to produce energy
• Help the body metabolize fats and protein
• Are necessary for a healthy nervous system, skin, hair, eyes and liver

The body's needs for niacin can usually be met through diet; it is rare for anyone in the developed world to have a Vitamin B3 deficiency.

The absorption of the B vitamins is not niacin dependent. Instead, the following factors are common culprits of Vitamin B absorption difficulties:

• Alcohol blocks Vitamin B absorption
• Tobacco smoke decreases Vitamin B absorption
• Certain digestive disorders like Celiac disease reduce Vitamin B absorption
• Intrinsic factor is needed to absorb Vitamin B12; its deficiency is seen in pernicious anemia

For any questions regarding supplements or vitamins one is taking or considering taking, it is important to speak with a physician, as well as your pharmacist for their professional opinions and recommendations.