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 Post subject: liver disease
PostPosted: Thu Aug 17, 2017 10:42 pm 
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Liver pathology seems to be rampant for various reasons. One may want to consider the below protocol:


Quote:
Triple Antioxidant Combo Improves Outcomes in Patients Who Have Hepatitis C
Saturday, 15 January 2000 00:08 By Erik L. Goldman | Editor in Chief - Vol. 6, No. 3. Fall, 2005

PHILADELPHIA—A triple antioxidant protocol combining alpha-lipoic acid, selenium, and silymarin can improve outcomes in patients with hepatitis C, in some cases averting the need for conventional interferon/ribavirin treatment or liver transplant, said Burt Berkson, MD, at the annual meeting of the American Holistic Medical Association.

"I've never seen someone with frank hepatitis cured on conventional therapy," said Dr. Berkson, who practices in Las Cruces, New Mexico. "Viral loads may drop, but they quickly bounce back when treatment is stopped."

Standard therapy with pegylated interferon and ribavirin give clinically meaningful reductions in viral load in less than 50% of all patients. And that's for the more susceptible HCV types 2 and 3. The numbers are under 20% for HCV type 1. These drugs also carry a significant side effects burden of severe flu-like symptoms, anemia, depression, thrombocytopenia, autoimmune reactions, renal problems, hair loss, and neuropsychiatric symptoms.

"This is definitely a situation in which the treatment is often worse than the disease. We need something else. We need to try non-toxic protocols first," said Dr. Berkson.

For the past decade, Dr. Berkson has utilized an antioxidant protocol consisting of alpha-lipoic acid (ALA), 300 mg, twice daily; oral selenium, 200 mcg, twice daily; and oral silymarin (Milk Thistle), 300 mg per day. "I put all people infected with HCV on this combination, even if they are asymptomatic. I think you can prevent progression to frank liver damage."

The antioxidant combination increases platelet count, increases albumin production, reduces ALT and slows prothrombin times to near normal. In some cases, abdominal ascites are resorbed. In addition to the ALA, silymarin and selenium, Dr. Berkson also recommends a good B vitamin complex because high dose ALA will deplete thiamine, niacin and riboflavin.

This combination of nutrients forms the nucleus of a comprehensive nutrition and lifestyle approach that emphasizes a vegetable and grain-rich diet, stress reduction, avoidance of highly processed foods, iron-rich foods (iron promotes hepatic damage), and elimination of tobacco, alcohol and other substances of abuse. He often advises patients to take coenzyme Q10, omega-3 fatty acids, psyllium fiber, and beta-carotene, while avoiding over-the-counter medicines like Tylenol that can be very damaging to the liver.

A study by US Army researchers looking at hepatitis C in Korean War era veterans showed that lifestyle factors were a major predictor of poor outcomes. Poor diet, high stress and frequent alcohol use were strong predictors of disease progression and death (Seeff LB et al. Ann Int Med 2000; 132(2): 105–11).

Dr. Berkson initially published his triple-antioxidant protocol in 1999, in the context of a pilot study involving three patients with cirrhosis, portal hypertension, and esophageal varices related to HCV. All three were candidates for liver transplant. After a year on ALA, selenium and silymarin, all were healthy, showed improved hepatic function, were able to return to work, and most importantly, avoided transplant (Berkson BM. Med Klin (Munich) 1999; 94 suppl.: 84–9).
Assessment and Evaluation

There are many different lab tests that can be used to assess the hepatic and overall health status of a patient with HCV. Unfortunately the numbers often lead to more confusion than clarity. Dr. Berkson relies on four key measures: platelet count, albumin levels, alanine aminotransferase (ALT), and viral load.

Platelet Counts: Progression of hepatitis-related liver damage leads to hepatic congestion and portal vein hypertension. This, in turn, leads to splenomegaly. As this occurs, platelets sequester, leading to measurable thrombocytopenia.

Albumin Levels: As virally induced apoptosis continues in the liver, albumin production tends to drop, making this a good marker for overall liver damage.

Alanine Aminotransferase (ALT): Elevated ALT may or may not be predictive of severity or poor outcome in hepatitis C. However, an abnormally low level of this enzyme is a clear indicator of end-stage cirrhosis. "They just don't have enough liver cells left to produce the ALT enzyme," said Dr. Berkson. Consequently, it is an important value to keep an eye on.

Viral Load: While it is important to track viral load, it is essential to remember two things: First, there is no clear correlation between serum HCV levels and the degree of liver damage. Second, viral testing methodologies, especially those based on polymerase chain reaction (PCR) technology, give highly variable and often exaggerated results. Particle estimates based on PCR are, "an artificial amplification of the actual amount of virus present in the blood, often by many millions," said Dr. Berkson. Any single measurement of viral count is essentially meaningless; only by tracking viral load over time, using a consistent method, can one assess viral activity.

Lab tests should be part of a comprehensive assessment that includes careful history, and diet and lifestyle assessment. Careful physical evaluation is also important. In particular, clinicians should be on the lookout for ascites. The portal hypertension secondary to cirrhosis often causes a ballooning of the small vessels of the digestive tract.
Alpha Lipoic Acid

Dr. Berkson's interest in ALA extends back to the 1970's. In 1979, he published an article describing use of ALA, then called thioctic acid, as a rescue therapy for acute hepatotoxicity caused by ingestion of Phalloides mushrooms (Berkson BM. N Engl J Med 1979; 300(7): 371). ALA is one of nature's strongest antioxidants, particularly in neutralizing superoxide free radicals. "I figured that if it could be used in acute liver disease, it might be useful for chronic liver disease as well."

ALA, a veritable sponge for free radicals, is produced naturally by the body in large quantities when we are young, but tends to drops off with age. In inflammatory diseases, especially with a lot of macrophage activity, there are a lot of superoxide free radicals to sop up (Sigalou AB. Antioxid Redox Signal 2002 Jun; 4(3): 553–7). "In Russia, they use ALA for people with myocardial infarctions, to limit ischemic damage."

ALA is also a key co-factor in the enzymatic processes by which pyruvate is converted to acetyl co-A (Roche TE, Cate RL. Biochem Biophys Res Commun 1976; 72(4): 1375–83). "Without it, we get no energy from our cells."

Organ meats are a rich dietary source of ALA, though it would be difficult to get therapeutic levels from diet alone. The majority of ALA supplements are derived from either tissue culture or they contain synthetic ALA.

For most HCV patients, oral supplementation with 300 mg ALA, twice daily, is sufficient to control free radical damage in the liver, said Dr. Berkson. He stressed the importance of selecting products carefully. "Use a good one. Make sure it is from European source materials," to rule out contamination or sub-therapeutic dose levels. He recommended ALA products by Metabolic Maintenance (www.metabolicmaintenance.com) and Bio Tech Pharmacal (www.bio-tech-pharm.com), though he has no financial ties with either company and acknowledged there are other high-quality products on the market as well.

Some patients with advanced disease, especially those with severe cirrhosis, require intravenous ALA. Dr. Berkson gives this as 100 mg IV, twice daily for five days. The main difficulty with IV ALA is that the product, Thioctacid 600T, is not available in the US. It is made by a German company called AstaMedica. "Aventis was going to come out with it in 2006, but it looks like that's not going to happen. You have to write prescriptions for each patient, and have them order from pharmacies in Germany. A few compounding pharmacies in the US can make it, but you need to ask about the source. It must be IV prescription grade."
Selenium

This trace element is, "almost like a birth control pill for retroviral replication," said Dr. Berkson. When selenium is low, viral replication increases. As you raise the selenium level, you reach a point at which viral replication just stops. The mechanism behind this effect is not entirely clear.

In treating patients with HCV, he recommends 200 mcg oral selenium as selenium methionine, twice daily. There is also an intravenous form, called Selinase, which is available in Germany, but he seldom uses it. "We've had such wonderful results with the oral selenium that there's really no need to go IV."

It is very important to keep the daily dose around 400 mcg. Higher levels will add nothing to improve antiviral efficacy, and a daily intake of 800 mcg can be toxic. "You don't want to go too high or people will start feeling sick, develop skin problems and in some cases lose their hair."
Silymarin

Silymarin is an aggregation of flavonolignans derived from the Milk Thistle plant (Silybum marianum), and it is the most commonly used botanical medicine for liver diseases.

According to a summary from the Agency for Healthcare Research and Quality (AHRQ), Silymarin has anti-oxidant and antifibrotic effects in the liver. It also appears to block the entry of toxins into liver cells, and down-regulates inflammation (Agency for Healthcare Research and Quality 2000. US DHHS, Publication 01-E024).

There are three well-designed clinical trials of silymarin in hepatitis patients in the medical literature; all show measurable benefit, though in one of the three, the findings were not statistically significant. (For a review of Silymarin and other natural therapies for Hepatitis, join www.holisticprimarycare.net and download our article, "Nutritional Therapies, Botanicals Can Improve Outcomes in Chronic Hepatitis" in our July 2003 edition.)

As part of his triple antioxidant protocol, Dr. Berkson recommends a total of 1,800 mg of a standardized silymarin product, to be taken in divided doses. Typically, this involves taking three 300-mg capsules with breakfast or lunch, and another three capsules at dinner.

The triple antioxidant regimen is a long-term treatment strategy, though many patients report rapid improvements. According to Dr. Berkson, "People say they feel better after one week, and after one month they feel great. Even those who continue to drink alcohol seem to do pretty well on this protocol."

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 Post subject: Re: liver disease
PostPosted: Thu Aug 17, 2017 10:44 pm 
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Quote:
Alpha Lipoic Acid and Liver Disease
by Burton M. Berkson, MD, MS, PhD






Alpha Lipoic Acid (ALA, thioctic acid, pyruvate oxidation factor) was first discovered by bacteriologist Irwin C. Gunsalus in 1948 when he observed that aerobic (oxygen-requiring) bacteria could not grow without it. Later, Gunsalus and Lester Reed determined the true structure and named it ALA (1951). ALA is a natural substance, produced in every higher-type cell, and it has many functions. Probably most importantly, ALA is the rate-limiting factor for the production of energy from carbohydrates (pyruvate). Without ALA, you could not obtain energy from the food you eat, and you could not stay alive.

ALA is also an excellent antioxidant and recycles other nutrients such as co-enzyme Q-10, vitamin C, and vitamin E. In addition, ALA chelates heavy metals such as mercury, lead, and arsenic, and it stabilizes NF kappa B transcription factor so that it helps to inactivate deleterious genes. It can also help people with diabetes mellitus by increasing the sensitivity of their cells to insulin, and it helps reverse diabetic neuropathies.

The first large human clinical studies using ALA in the United States were carried out by Drs. Fredrick C. Bartter, myself, and associates from the National Institutes of Health (NIH) in the 1970s. We administered ALA to 79 people with severe and acute liver damage at various hospitals around the United States, and 75 recovered full liver function.

Dr. Bartter and I were appointed by the FDA as principal ALA investigators, and I went on to use it successfully for the treatment of chronic liver disease. In combination with low-dose naltrexone, I have used ALA to treat various cancers for which no other treatment exists. (For more information, readers might want to go to PubMed and type in "liver, Berkson.")

My first experience using antioxidant therapy was in 1977, when I was an internal medicine resident. A man was poisoned and suffering from acute liver failure. His liver function tests were in the thousands of mg/dL, and he had propulsive diarrhea, projectile vomiting, and dreadfully painful muscle spasms throughout his body. He was the sickest person that I had ever seen. Due to the relentless muscle cramping and pain, he could not find a comfortable resting position. One of the department chiefs told me that nothing could be done to save his life except for an immediate liver transplant, however, a donor liver was not available. I was ordered to administer medical support and to just observe the patient as he went though the phases of death. I was told to take notes and prepare a report for grand rounds at the hospital.

Death from liver necrosis usually involves four separate stages: (1) ingestion of a poison, such as acetaminophen, a poisonous mushroom, hepatotoxic hydrocarbon solvent, etc.; (2) development of acute and difficult gastroenteritis with dehydration, pain, and electrolyte depletion; (3) a noticeable recovery phase in which the patient is often released from the hospital in a weakened state; and (4) increased weakness followed by coma and death. Because I did not want to see this happen to my patient, I began a search for a way to reverse his condition.

Fortunately, I remembered reading an article about a new drug that had been shown to be helpful in the treatment of severe liver damage. The drug, alpha-lipoic acid (ALA) was stocked at the NIH by Fred Bartter, MD, the chief of endocrinology. Dr Bartter was interested in this agent because he thought that because it lowered blood sugar levels, ALA might be used as a drug for diabetes mellitus and its complications.

About 30 hours after my patient had ingested the deadly toxins, the intravenous (IV) ALA was started. Within a few hours, the patient began to feel better. We were all surprised that he continued to improve, and he was soon discharged from the hospital with nearly normal laboratory values and feeling a little tired, but normal. He is still well and free of liver disease, 30 years later.

After I treated three more patients with severe liver damage with ALA and obtained the same remarkable results, most of the hospital chiefs were still skeptical, however, Dr. Bartter and I were delighted. NIH sent a team of doctors to Cleveland to examine my patients, and I was eventually awarded the FDA investigational drug permit for the use of IV ALA. Dr. Bartter and I published three papers describing our successes with IV ALA, and we expected a certain amount of interest in this remarkable organ regenerative protocol. We were disturbed by the lack of attention from the American medical community. Dr. Bartter died in 1985, and I continued to study ALA as a therapeutic agent and as a nutraceutical.

Since my work with Dr. Bartter, I have treated hundreds of patients with IV and oral ALA for acute and chronic liver damage, autoimmune disease, cancer, etc., along with other interesting agents with promising results. Below are a few case studies of Hepatitis C taken from my office practice.

In my opinion, there are four laboratory tests that really tell a doctor what is going on in the liver. The first is the platelet count. It is important because as liver inflammation and scarring progress, the platelet count goes down. So, the platelet count is a very helpful indirect indication of liver health, and a rise in platelet count is an indication of a healing liver.

I believe that the albumin level is the most important liver function test. A diseased liver can only produce a small amount of albumin. So a person with severe liver disease has a low albumin level, and as the liver improves, the albumin level rises.

The ALT is a liver enzyme that results from damage to the liver. It normally goes up and down from day to day, however, a downward trend may suggest an improvement of liver function. Interestingly enough, in cases of severe liver disease, the ALT is very low because most liver cells have been killed off.

The prothrombin time is a very important tool for measuring liver health, because a sick liver cannot produce much of the clotting factors, and thus the prothrombin time (a time it takes the blood to clot) is elongated in severe liver disease. As the liver regenerates, the prothrombin time shortens.

Case 1
Mr. CA, a 68-year-old salesman from Ohio was infected with hepatitis C, following a blood transfusion in the hospital. Soon afterwards, he became ill and was found to have hepatitis C. He was sent to a hepatologist who immediately put him on interferon and ribaviron, which made him feel as if he had influenza for several months, and the drugs ultimately damaged his bone marrow. After the failure of interferon/ribaviron, Mr. CA was told that nothing could be done other than liver transplantation.

Mr. CA presented to my office suffering from fatigue, anxiety, abdominal pain, and anemia, and his abdomen was distended with fluid (ascites). I treated him with my triple antioxidant therapy. Within a short time he began to feel normal and was free of the signs and symptoms of liver disease. Some of his results may be seen in figures 1, 2, 3, and 4. (33KB .pdf)

Case 2
Mr. EA, a 54-year-old man from California was infected with hepatitis C during a blood transfusion following surgery. He did not feel well for several years following surgery, and his physician did some laboratory tests that demonstrated hepatitis C. A liver biopsy showed moderate cirrhosis with active inflammation.

Mr. EA presented to my office with fatigue, anxiety, abdominal pain, and some ascites. His ALT was elevated, and his viral load was elevated by the Chiron PCR method. I treated him with my Triple Antioxidant Therapy (ALA, selenium, and silymarin), and within a few months, he started to feel normal. Some of his results are illustrated in figures 5, 6, 7, and 8.(31KB .pdf)

Case 3
Mrs. KVP is a 40-year-old woman in excellent health who developed hepatitis C from a blood transfusion following surgery. Her family doctor sent her to a liver expert who told her that she was seriously ill and must be treated immediately with interferon and ribaviron. KVP had no complaints and had heard that the standard treatment often made people much sicker than doing nothing.

KVP presented to my office, and her blood tests were all normal, except her ALT liver enzyme was elevated at about 300 mg/dL. This indicated that there was viral activity and inflammation in her liver. KVP's original laboratory tests and her progress after being treated with my triple antioxidant therapy over three years are demonstrated in figures 9, 10, 11, 12, and 13. (41KB .pdf)

After three years, she once again visited her hepatologist who told her that actually that she was getting sicker because her viral load had increased dramatically (Figure 12 in above .pdf). Again, he said that she should be put on interferon and ribaviron and be evaluated for a liver transplant. Incidentally, she had great health insurance.

Mrs. KVP is a health professional and questioned her hepatologist. She asked him if the original viral load was acceptable. He said, yes, however, it had increased from 600,000 to 6,000,000 units, and that showed progression of her disease. She asked him if he knew that the first viral load tests were done by the Chiron method and the second tests were done by the Quantasure method. He did not know that. Then, she told him that viral load is an artificial exaggeration (amplification) of the amount of viruses by millions, and the Quantasure method appears to amplify the amount of viruses by ten times more than the Chiron method. After hearing this reasonable explanation, he answered that viral load was not a very important test anyway.

The three people described in this study continued to stay on the triple antioxidant therapy, and I still see two of them as patients today (Fall 2007). The two continue to improve. In addition to ALA, I added silymarin and selenium to my triple antioxidant therapy, because these agents also protect the liver from free radical damage, regenerate the other fundamental antioxidants, and interfere with viral replication. Although my first acute hepatic necrosis patients were treated with ALA alone and did exceedingly well, all the patients presented in this paper followed the triple antioxidant program and recovered quickly from their illness.

The standard-of-care treatments for severe liver damage, especially liver transplant surgery, can be painful, disabling, and extremely costly. From my experience in my practice, interferon and antivirals have less than a 30% improvement rate, and this response is usually not permanent. Liver transplant surgery in a few cases can be lifesaving and necessary, but is uncertain and tentative, partly due to the residual viremia that ultimately infects the newly transplanted liver. I have found that the highest viral loads are seen following liver transplant surgery, since the residual viruses in the bloodstream and tissues have a new healthy liver on which to feed.

The triple antioxidant therapy offers a more conservative approach to the treatment of hepatitis C that is much less expensive. One year of antioxidant therapies described in this paper costs only a few thousand dollars, whereas liver transplant surgery costs more than $400,000 a year, and in five years, the person will probably require a new transplant. And, in addition, the transplant patient will require anti-rejection drugs and many doctor and hospital visits. It appears reasonable to me that prior to transplant evaluation or during the transplant evaluation process, this conservative triple antioxidant treatment program should be considered. If there is a significant improvement in the patient's condition, liver transplant surgery may be avoided.

Not too long ago, I was invited by the Internal Medicine Society of Saxony to present my triple antioxidant protocol to the group in Dresden, Germany. I was asked why viral loads did not always fall to very low levels with my treatment program. I answered that from a microbiologist's point of view that I did not believe that one could ever completely eradicate a viral disease without killing the patient. I added that we could only hope to support and "teach" the immune system how to recognize and control a virus. Normally, viruses remain part of our biology for the rest of our lives. And this does not necessarily make a person sick. We are all filled with billions of dormant viruses. As long as we have a healthy lifestyle and avoid unnecessary emotional and physical stress, the viruses should remain dormant. I believe that one can live to 100 years old with hepatitis C and still be a healthy person.

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