October 2001

by Nicholas Calvino, D.C.

            Nicholas Calvino, DC is a Nutritional Consultant and is a noted author and lecturer on the subject of health and nutrition.  His company, Natural Health Partners, LLC is the first Practice Enhancement company specializing in physician branding and managing secondary profit centers. He currently resides outside of the Detroit area and is working on opening a branch of the Fibromyalgia Research Center on the East Coast. drcalvino @msn.com www.drlowe.com

Hepatitis C is a major Public Health threat.

            Hepatitis C is a major Public Health threat and of major concern to all Health Care Practitioners because of the prevalence and long term consequences of the disease. It is the most common U.S. blood borne infection, and affects close to four million people. This is approximately four times the number of HIV infected individuals.1  From a Chiropractic and Holistic Practitioner’s position, Hepatitis C infected individuals are very likely to exist in their patient populations.  The Hepatitis C patient typically will present with a variety of functional, but not necessarily overt symptoms that span multiple organ systems.  The hepatic damage is due to both the cytopathic effect of the virus and the inflammatory changes secondary to immune activation.2  Accurately recognizing the source of these problems allows referral of the patient for appropriate diagnosis.  Informing a positively identified Hepatitis C patient  of their options is an  important aspect of improving quality of life and increasing clinical success. 

            Hepatitis C is the most common cause of chronic liver disease, cirrhosis and hepatocellular carcinoma in the Western World.  Chronic Hepatitis C is asymptomatic 95% of the time.  It is estimated that more than 30% of patients with chronic Hepatitis C develop cirrhosis.  Thus, this liver disease can lead to end-stage liver disease despite the presence of few symptoms and signs of illness. 

Functional Assessment of patients.

            Because of its chronic, sub-clinical character, Hepatitis C often goes undiagnosed.  In my clinical opinion, it is more effective to identify subjective symptoms and risk factors (see table 1.1 and 1.2) in determining the possibility of Hepatitis C infection.3  Any patient, or client, with these risk factors, and especially if they have functional and viscero-somatic signs and symptoms of liver involvement, is a good candidate for Hepatitis C screening since 70% chronic carriers are asymptomatic.  When symptoms are present, the most common are fatigue (70%), abdominal pain/discomfort (20%), anorexia (15%) and weight loss(5%). The majority of chronic HCV carriers have hepatomegaly (70%) while some have an enlarged, palpable spleen (20%).  Only 25% of acute HCV cases develop jaundice.4

            From a functional analysis, because Hepatitis C attacks the liver, there are sub-clinical systemic multi-system complications.  For example, the conversion of B-vitamins occurs in the liver and secondary impairment can lead to changes in circulating hormone levels, decreased ability to detoxify and neurological manifestations.  Non-specific signs and symptoms may include pain over the rib cage on the right side, back and right shoulder pain, itchy skin, alternating stool color, fluid retention, foul body odor, sclera of eyes appear yellow, easy bruising, halitosis, migraine (traditionally seen in botanical medicine as a liver issue) aching muscles not due to exertion.  Often times the patient with a poorly functioning liver will have symptoms of sluggish digestion, fat intolerance, flatulence, bloating, nausea, chronic constipation and chemical, food or drug intolerances.5 

            Obviously, secondary to somato-visceral and visceral-somatic reflexes, many of these patients will seek Chiropractic care as they often complain of sub-clinical neurological and diffuse musculoskeletal symptoms.  Therefore, it is imperative to use a general holistic health screening questionnaire in the office.  If you want to see the whole patient, you must assess the whole patient.  Many nutritional companies provide general screening questionnaires that provide a subjective analysis of all major organ systems. 

Conventional and Alternative Options.

            Despite progress in detecting and treating Hepatitis C, at present, there are no specific non-toxic and effective proven treatments for Hepatitis C.  Alpha interferon is the only FDA-approved therapy for chronic Hepatitis C.  Interferon treatment, however, is expensive and often poorly tolerated due to its numerous side effects and results in beneficial long-term responses in only a minority of patients.6  Failure to respond to Alpha Interferon occurs in 40-60% of patients, 15-45% relapse and only 15-25% show a positive response.  The side-effect profile of interferon Alpha Interferon (alfa2b) is high and includes nausea, headache, fever, myalgias, fatigue, leukopenia, thrombocytopenia, alopecia, irritability, depression, thyroid abnormalities, pulmonary complications, and retinal damage.7  Patients not responding to treatment with interferon after three months, or who experience serious side effects, are not good candidates for continued interferon therapy.  Unfortunately, there have been very few alternatives which could provide objective improvement in clinical indicators and symptoms and that were non-toxic. 

            Recently, a proprietary blend of three Korean and Chinese Botanicals have been introduced into the U.S. Market8 that has shown in pilot clinical trials to be non-toxic and provide substantial clinical and symptomatic resolution of Hepatitis C.9  In this study, six males and four females between the ages of 41 and 68 (avg. 54.4 yoa), all diagnosed as positive for Hepatitis C anti-bodies with elevated liver enzymes (ALT/GPT) were given a proprietary blend of herbs.  The preparation consisted of two 500 mg capsules of 3 herbs given twice daily for 24 months. All patients showed a good response and their viral load (HCV-RNA) levels gradually lowered from one-billion or one-hundred million to one thousand copies/ml serum during the study.  In other words, viral loads decreased 1,000,000 to 100,000 times.  Patients in the study also reported improved quality of sleep, increased physical energy, improved countenance, increased body weight and smoother and softer skin. 

            Non-toxicity was confirmed by a separate analysis by the Institute of Life Sciences and Chungbuk National University in Korea.  Their results concluded that “. . oral administration [of a proprietary herbal formula] for 28 days, even at 20 times higher human therapeutic doses, dose not cause any adverse effect to the body.”

            This blend of three Traditional Botanicals contains Patrinia Villosa, Artemesia Capillaris, and Schizandra fructus.  The three herbs in this formulas have been shown to be hepatoprotective, support the regeneration of liver cells, increase the flow of bile, lower bilirubin and cholesterol levels and to be anti-viral.10 11 12 13

Quality and Safety of Botanical Products:

            If your patient decides to utilize complementary treatment or experiment with herbal support for Hepatitis, or any other condition, it is essential to counsel them on the differences in quality between herbal products.  Many herbal products are contaminated with heavy metals, pesticides, bacterial, mold/fungus, etc. . , therefore, it is important to establish a relationship with quality herbal manufacturers as these contaminants can further exacerbate hepatic damage by further stressing and already under functioning liver.14 15 16

Summary

            Hepatitis C is a serious and common problem that practitioners are likely to encounter.  The disease often lacks overt signs and symptoms and, therefore, often evades diagnosis.  It is imperative to “dig deeper” when evaluating a patient coming in with functional disturbances that could possibly be linked to the liver, especially when those disturbances are accompanies by one or more exposure risk factors.  Until now, if a diagnosis of Hepatitis C is made, there have been no effective remedies that were safe, well-tolerated and effective.  Preliminary evidence on a proprietary blend of Korean and Chinese Herbs now available in the U.S. for remediation of Hepatitis C is very promising and appears to be a worthy of further investigation. 

References

1. Center for Disease Control Fact Sheet:  www.cdc.gov/ncidod/diseases/hepatitis/c/fact.htm

2. Lyn Patrick, ND, Hepatitis C: Epidemiology and Review of Complementary/Alternative Medicine Treatments, Altern Med Rev 1999;4(4):220-238

3. Alter MJ. Epidemiology of hepatitis C. Hepatology 1997;26:62S-65S

4. Gienstag JL.  Gastroenterology 1983;85:439-62.

5. Simon Mills, Kerry Bone. “Principles and Practice of Phytotherapy” Churchill Livingstone, New York, 2000.  ISBN 0 443 060169

6. Lindsay KL.  Therapy of hepatitis C: an overview. NIH Consensus Development Conference: Management of Hepatitis C. April 1998. National Institutes of Health, Bethesda, Maryland.

7. McHutchinson JG, Gordon SC, Schiff ER, et al. Interferon alfa-2b alone or in combination with ribavirin as initial treatment for chronic hepatitis C. N Eng J Med 1998;339:1485-1492.

8. Allergy Research Group/Nutricology.  30806 Santana Street.  Hayward, CA 94544.  www.nutricology.com.  800-545-9960

9. Allergy Research Group, In Focus Newsletter, Winter, 2000:  www.nutricology.com/Newsletter/eurocel.htm

10. The Review of Natural Products by Facts and Comparisons. St. Louis, MO: Wolters Kluwer Co., 1999.

11 Liu GT. Pharmacological actions and clinical use of fructus Schizandrae. Chin Med J 1989;102:740-749.

12 Li XY. Bioactivity of neolignans from fructus Schizandrae. Mem Inst Oswaldo Cruz 1991;86:31-37.

13 Stern, Elaine. Two Cases of Hepatitis C Treated with Herbs and Supplements. The Journal of Alternative and Complementary Medicine, Vol. 3 (1), 1997, pp. 77-82.

14 Moore C, Adler R.  Herbal vitamins: lead toxicity and developmental delay. Pediatrics 2000 Sep;106(3):600-2

15 Bateman J, Chapman RD, Simpson D.  Possible toxicity of herbal remedies.  Scott Med J 1998 Feb;43(1):7-15

16 Private conversation with Steve Levine, PhD.  President:  Allergy Research Group/Nutricology.  30806 Santana Street.  Hayward, CA 94544.