Chinese Medicine and CAM Therapies: Dealing with Side-Effects of Interferon Therapy in Hepatitis C
By Misha Cohen, OMD, LAc
At my clinic in San Francisco, and in many clinics in the United States, Mexico and Canada, practitioners are using a treatment protocol for assisting with interferon/ribavirin therapy in people with the hepatitis C virus (HCV).
We are having success with alleviating side-effects, and are apparently helping to improve bone marrow suppression related to both the Pegasys and Peg-Intron brands of pegylated interferon therapies.
One goal of Chinese traditional medicine and complementary and alternative medicine (CAM) during interferon therapy is to help people continue with close to full-dose therapy of Western medications, and not have to discontinue during therapy due to side-effects. There is sufficient documentation in peer-reviewed clinical trials that staying on at least 80 percent of the interferon and ribavirin dose, at least 80 percent of the time, is crucial to sustained viral response (viral clearance at six months).
Body acupuncture and auriculotherapy are highly effective for treating side-effects associated with interferon and ribavirin. They are also used when a person is trying simultaneously to reduce or eliminate drugs such as heroin, morphine, cocaine, alcohol and nicotine.
Chinese and Western herbal medicines may be used safely in conjunction with interferon/ribavirin therapy, when a qualified licensed acupuncturist and/or herbalist is familiar with both hepatitis C and the contraindications of herbs or herbal formulas in hepatitis C and during drug treatment. The following is a summary of the Chinese traditional medicine optimum protocol used during interferon/ribavirin treatment that is part of the continuing education training for hepatitis C professional certified practitioners:
Protocol 1. Optimally, Chinese traditional medicine treatment should be started no less than 12 weeks prior to interferon treatment . It is the author's preference to begin six months to one year prior to interferon therapy. This is thought to give the best results for completing interferon therapy effectively.
A. The licensed acupuncturist, Western or other licensed provider should run lab tests, including:
PCR (viral load) or other cellular testing such as TMA tests and bDNA tests;
complete blood count (CBC), including white blood count (WBC), hematocrit, hemoglobin, red blood count (RBC), differential (neutrophils/granulocytes, etc.), platelets;
liver function tests, including albumin, and total bilirubin, including direct or indirect bilirubin;
liver inflammation tests such as ALT (alanine aminotransferase), AST (aspartate aminotransferase), GGT ( gamma-glutamyltranspeptidase ), etc.; and
international normalized ratio (INR) measured clotting time (previously known as prothrombin time).
B. Begin Chinese herbal treatment for hepatitis C:
hepatitis herbal pills (we use specific formulas);
immune formula (the herbalist's choice according to diagnosis);
marrow-strengthening herb formula; and
silymarin (standardized extract from milk thistle).
C. Begin on the supplement plan:
Lactobacillus acidophilus: Use a refrigerated, powdered type (use as directed on the bottle). This often helps many of the digestive problems that may be associated with hepatitis C. People who have taken many antibiotics, or a high dose of antibiotics in the past, may actually have very little naturally occurring lactobacillus acidophilus in the gut, which can lead to bowel disorders. Stool tests, such as the helicobacter pylori assessment, are recommended in this case, to see if there is a deficiency in lactobacillus acidophilus . In this case, your doctor may recommend a higher dose than what is recommended on the bottle.
Multivitamin, multi-mineral supplements in powder capsule form are best for digestion. B-complex vitamins may make some people with hepatitis nauseous. Make sure the vitamins provide an ample supply of selenium and chromium. It is best for people with hepatitis C that the formula not include a lot of herbal substances and that herbs be provided separately, unless an HCV-knowledgeable practitioner has prescribed the specific formula.
Essential fatty acids (EFAs): Take one tablespoon per day of organic flax, raw sesame, or evening primrose oil to promote prostaglandins. I also use organic borage oil when there are skin problems, such as itching and redness. Fatty acids help decrease muscle aching and fibromyalgia symptoms, and should be of the refrigerated type, in order to avoid rancidity.
Low-dose carotenoids and lycopenes: Consume 5,000-10,000 units per day. (Do not take vitamin A.) Lycopenes are found in vegetables, such as tomatoes, and have been studied extensively and found to have anti-carcinogenic effects. Many old-time vitamin manufacturers have recently added lycopenes to their formulas because of these recent studies.
Vitamin E: 400 to 1,200 IU per day can help with cell-mediated immune function, skin problems, and memory loss.
Vitamin C: If you can tolerate it, you can take up to six grams per day. Take to bowel tolerance (until you experience too much gas or loose stools), then reduce intake until comfortable. However, vitamin C should not be taken along with red meat, as it increases the uptake of iron, which may damage the liver further.
Only a licensed nutritionist or a trained, qualified practitioner should recommend additional supplements. It is important that you consult your physician when adding a supplement program beyond the basic supplements recommended at the beginning of this article.
Strategy: For an additional supplement strategy, Dr. Lyn Patrick of the Hepatitis C Caring Ambassadors programs recommends what she considers an essential combination of 1,200 IU of vitamin E, 400 mcg selenium and 600 mg of alpha lipoic acid (ALA - from thioctic acid). She also recommends taking a combination of B vitamins along with this regime, as ALA can deplete the B-complex.
D. Begin acupuncture therapy protocol treatment
Protocol 2. Two weeks prior to interferon treatment, we do the following:
A. The Western or Chinese provider should run all lab tests, including:
PCR (viral load) or other cellular testing, such as TMA and bDNA tests;
complete blood count (CBC), including white blood count (WBC), hematocrit, hemoglobin, red blood count (RBC), differential (neutrophils/granulocytes, etc.), and platelets;
liver function tests, including albumin and total bilirubin, including direct or indirect bilirubin;
liver inflammation tests: ALT, AST, GGT, etc.; and
B. The Chinese medicine herbal practitioner individually modifies Chinese herbal treatments and supplements for HCV:
discontinue St. John's Wort and other related formulas; and
discontinue any formulas containing chai hu (bupleurum).
C. Continue acupuncture therapy
Protocol 3. Week one of first interferon shot:
A. Run CBC (to determine need for additional herbs or supplements, or whether discontinuation is necessary or referral to the Western physician for medications is needed).
B. Begin acupuncture the same day or the day after the first interferon shot, depending on when your symptoms begin. This may take one or two shots to determine. Pegasys and Peg-Intron appear to have slightly varying patterns in different individuals. Two acupuncture treatments per week for the first four-to-six weeks are suggested to relieve side-effects most successfully.
C. The herbalist will increase or decrease herbs as necessary according to both Chinese traditional diagnosis and Western lab parameters.
Protocol 4. Weeks 2-4 of interferon therapy:
A. Check labs (CBC only) for WBC, platelets, RBC, etc.
B. Check PCR or other cellular tests on weeks two and four (if possible).
C. Adjust the marrow-strengthening formula according to labs as well as Chinese diagnosis.
Protocol 5. Weeks 5-24 (genotypes 2-3) or 48 (genotype 1)
A. Treatment according to Chinese diagnosis
B. Treatment according to labs
A list of hepatitis C professional certified practitioners (licensed acupuncturists and herbalists) can be found at www.docmisha.com. You can download the full list of certified practitioners in a PDF file.
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