Question and answer session with Claudia Lauch, Western Medical Herbalist/Nutritionist at The Hepatitis C Trust 26th July 2006
Herbs and supplements can be powerful and as with any medicine are processed by the liver and need to be treated with respect. Just because they are natural does not mean they are not potent and potentially harmful even. Natural does not mean safe! Your alternative therapist should be informed of any conventional treatments that you are using. It is also important that you tell your liver specialist and GP about any herbs or supplements you are using.
St John's Wort - is it safe?
Q There seems to be alot of controversy and misinformation about the safety of St John's Wort. Would you recommend it for someone with hepatitis C and sporadic depression and what would you say is the best form and dose to take.
A Yes there is quite a bit of confusion around St John's Wort (Hypericum) as it is a complex herb. It should not be used in conjunction with other drugs, whilst on the pill or on hepatitis C treatment. Some people experience photosensitivity, but I have never experienced this in my own practice. There are some interesting scientific studies which suggest Hypericum works against enveloped viruses, such as the hepatitis C virus. Not only this, but some studies have suggested that it could be used orally against vitiligo, HIV-AIDS and even cancer. I use it quite frequently in my own practice for hepatitis C and depression and many of my patients appear to benefit from it. However, I use it only in patients who are not any other form of drug. The active constituent working apparantly against enveloped viruses is Hypericin. However, I recommend you see a good herbalist and do not self-medicate, as we herbalists would mix hypericum in a tincture with other herbs to target the whole disease profile of the patient.
Blurred vision/joint pain/feeling light headed
Q I have symptoms of blurred vision, joint pain and I feel light headed. Any advice will be most welcome.
A I would normally need a little bit more information such as: How long have you have had hepatitis C for, what genotype are you, are you or were you on interferon/ribavirin treatment, or are you taking currently any supplements or herbs, as all this factors may influence in one way or another your symptoms.
However, all your symptoms are associated with disease progression (chronic) of hepatitis C and worsen whilst on treatment, and sometimes persist also after treatment. It would be important to rule out any autoimmune condition, which may arise due to the hepatitis C or treatment such as: Rheumatoid arthritis, SLE (Lupus) and others. Therefore I suggest you consult your doctor and ask him/her for a bloodtest which should include rheumatoid factor and ANA (anti-nuclear-antibodies), to confirm whether your symptoms could be related to an autoimmune condition.
Because of this I am reluctant to discuss any herbs as I am not sure of what exactly causes your symptoms. However, in terms of diet I would avoid: Excess salt, tomatoes (the solanacea family is renowned to worsen arthritic conditions), all citrus fruits and milk products (and of course alcohol). You can substitute milk products with goat milk products but not soya. Soya, biochemically speaking is metabolized through the same pathway as cow's milk. However, goats milk is not. I am happy to answer your question again in more detail if you give me a few more details.
Post treatment - still have side effects
Q I am a non-responder to treatment which ended in December 2005 after 48 weeks of treatment. I'n Genotype 5 and contracted HepC from a blood transfussion I had in the early '70s during re-constructive facial plastic surgery. During treatment I had few side effects - but the ones that are still with me (and in fact are worse post treatment) are massive skin irritations on both lower legs (including ankles)and dry flaky scalp and skin inside and around the ears. I also have very painful hip, knee and ankle joints.
Can you recommend any herbal treatments which will help clear up my skin problems. A dermatologist at my hospital prescibed Elicon(?) ointment but this has had no effect!
A From what you describe, flaky scalp and skin around the ears you have seborrheic dermatitis. This is a common skin disorder caused by an overgrowth of a type of yeast. I recommend a very good vitamin B complex (ideally prescribed by a good nutritionist - I for example recommend Biocare) as this will deal with the yeast overgrowth internally. Avoid refined sugars as these will feed the yeasts and they multiply faster. I suggest you take also a zinc supplement. There are quite a few shampoos which deal with seborrheic dermatitis and you can ask your pharmacist over the counter for it. One of the ones I use for my patients is called Nizoral. You apply it 3 times a week and leave it for 3 minutes and wash out. I also prescribe a special cream, which I make for my patients, containing borage oil and some anti-fungal/yeast essential oils. A good herbalist will be able to help.
In terms of joint pains, it is quite common in hepatitis C to be affected also after treatment by joint pains, which could be caused by an auto-immune condition, but not necessarily. To rule this out I advise you to ask you doctor for a blood test which includes rheumatoid factor and anti-nuclear-antobodies (ANA). Again a good herbalist can help you, once diagnosed, with a range of herbal treatments (Feverfew and Devil's Claw are some of those) with your joint pains and work as anti-inflammatories.
BTW, your cream Elicon, is a steroid cream (0.1% cortisol), i.e. corticosteroid, which may alleviate the itching temporarily but actually worsens seborrheic dermatitis symptoms in the long term.
Oestrogen levels - increased fibrosis post menopause?
Q I have just read on the hepc trust website that women past the menopause develop increased liver fibrosis due to lower oestrogen levels. Please can you advise me which foods are best to eat which contain oestrogen ? It's always bad news reading about hep c, lets read positive things which give us hope for a change.
A Low oestrogen, especially when in the menopause, causes quite a few imbalances in the body. It may influence a faster progression of fibrosis, although I believe that this has to do with a whole array of other factors as well. However, there are quite a few interesting herbs which deal with menopausal issues and are very, very helpful. Before I go on explaining those herbs I would like to say that you should consult a good, qualified herbalist who is aware on how to treat your hepatitis C with your menopausal concern.
Herbs which work are: black cohosh, wild yam, licorice, sage, hops, angelica sinensis and white peonia amongst some others. I prefer working with tinctures (alcoholic) as they are more effective in treating hormonal conditions. All the herbs I listed are oestrogenic herbs (phytoestrogens) which work as a herbal HRT and balance your hormones during menopause. Make sure that your herbalist prescribes your tinctures in a 1:1 (fluid extract) version which minimizes the alcohol content. You can then evaporate some of the alcohol by stirring some warm water into the tincture for a minute or so.
Post Treatment diet/herbs
Q I have recently finished treatment (9 mnths ago) of 6mnths prior to which I had a kidney removed due to a tumor. Could you please recommend a diet or herbal regimen that I could take on board to promote recovery from treatment and on-going liver support taking into consideration that I am minus 1 kidney.
I am currently using these herbs: schizandra berries, liquorice, artichoke leaf and dandelion root. I drink plenty of green tea and sprout my own wheat grass which I use about twice a week. The herbs I take with green tea in a big pot every morning. Thanks for any advice you can give.
A Having only one kidney requires much more thought in what to take in terms of foods and any form of medication (herbs, supplements or conventional). You mentioned that you are drinking a lot of green tea. I would advise you to drink only when you are thirsty as any form of fluid is metabolized through your kidneys, of which you have only one. By drinking too much you could literally 'drown' your kidney. I would be very careful with any form of self-medication and advise you to see a qualified herbalist. However, I would be very careful with licorice as this works as nature's steroid and taken over a longer period of time and/or high concentrations increases blood pressure, due to an effect on cortisol levels as well and the sodium/potassium balance. This increases the body fluid and could potentially damage your kidneys. Schizandra should be fine, but again be careful with dandelion although you mentioned you take the root, depending on the purity of your herbs (I don't know where you get them from?) it could be a mix with dandelion leaves, which are very diuretic and therefore harmful to your kidney. Artichoke leaf is good for the liver and wheat-grass not a problem really.
Post-treatment I would recommend milk thistle, as a fluid extract (1 portion of herb to one portion of alcohol) or some capsules of very high quality. Milk thistle increases the clearing of toxins through your liver, which you really want after treatment, and calendula works generally as a very good anti-inflammatory and would benefit your kidney as well. But again I would like to advise you to consult a professional herbalist.
In terms of diet, you should definitely avoid salt, as this causes water retention in your body and damages the kidney, including alcohol and saturated fats. If you are worried re the alcohol in a tincture you can evaporate most of it by adding some warm (never boiling hot as it would destroy the properties of the herbs) water to the tincture and stir it for a minute or so. However, the amount of alcohol you take in a tincture (5ml) is minimal.
Eating the right foods for my liver
Q My big concern is eating the right things for my liver. I've developed a hang-up about what I eat, so much so that it's taken away the enjoyment of eating. I don't have alcohol and do my best to eat healthily but I LOVE CHOCOLATE CAKES SWEETS AND BISCUITS. I'm a slim 8 stone but agonise over eating these things, my mouth almost drools when I pass them on the supermarket shelf knowing I should'nt eat them. I read that sugar has a similar affect as alcohol on the liver? Is this true? I usually have an ice cream, bar of chocolate, some biscuits and a piece of cake most days. Am I doing a lot of harm to my liver ? I don't understand why sugar is harmful to the liver, please would you explain to me? Otherwise I eat all wholefoods in my diet Claudia. I also agonise over trans fats, saturated fat, bacon, cheese and milk - basically all the good tasting things. Please can you give me some advice on enjoying my food more?
A It is advisable to limit the intake of the following: saturated fats (all fats which become hard at room temerpature), red meat, smoked items and tinned/canned food items. And of course alcohol . It is very important to minimize your salt intake as well and try and add as little salt as possible to your food. When it comes to sugar you should consider limiting the intake of 'white' bread, pasta and rice and go more for the wholegrain versions. However, bran is not advisable at all as this is very difficult to digest. I would definitely avoid cakes, ice-cream and chocolate in excess. Enjoy it as an occasional treat (once a week), without any guilt, but not every day!!! Chocolate is not very good for the liver and I would go for the dark version if you must. Hope this helps.
Sleeping Problems
Q What would Claudia recommend to aid sleep? My sleeping problems stem from the light in the early mornings waking me, is there anything she can recommend that might be able to counteract the body waking in response to light?
A There are quite a few herbs in terms of helping you with sleeping, however not really specifically in terms of light. But I would recommend a herbal mix which not only gets you off to sleep better but prevents you from waking up. Again, you should see a qualified herbalist for the mix which would include: passionflower (30%), valerian(30%) , hops (20%) and oats (20%). If you are sensitive to valerian ( some people are) you could substitute it with some scutellatia lateriflora (skullcap). P.S. Curtains may help also
Nettle Tea - Good for anaemia?
Q A friend has been going on to me lately that I should drink nettle tea as it is very beneficial and has loads of iron. Is this true? Is it a good source of iron for hepatitis-related anaemia? What else does nettle tea do for you?
A Are you sure you have iron-deficient aneamia? There are various forms of anaemia and therefore I would advise you, if you don't know, to find out which type of anaemia you have, as iron may not be beneficial in every type of anaemia. Also, excess iron is damaging to the liver and therefore I would be particurlarly careful in Hepatitis C. Although nettle tea does contain iron, it is a diuretic, therefore reducing the fluid volume in your body and therefore would counteract what you are trying to achieve and increase your iron levels in your blood. I suggest you find out if your aenaemia is related to iron deficiency and if you find out it is, you could increase some iron rich foods such as spinach, prunes and red meat. Nettle tea is usually prescribed for detox diets and elimination of excess water (oedema).
Milk Thistle
Q I'm about to start taken milk thistle again post treatment and have heard Silybin Phytosome is the way to go.I'm just a little concerned about the process involved in producing it. Do you have any knowledge of the solvents involved etc and if you have an opinion would it be better to stick with a completely natural product.Thanks in advance for any answer you may have.
A I am a western medical herbalist and do not work with standardized extracts as Silybin Phytosome appears to be.
As herbalists we believe that the synergy of all phytochemical constituents act together, and extracting only one of these constituents (sylimarin for example) is a very different matter: By extracting only one constituents you have a very high concentration of it in one capsule which is similar to the constituents occurring in 10 plants. Therefore the amount you are taking in one capsule is much higher than in any tincture or capsule/tablet prescribed by a herbalist. This high concentration could be associated with an increased chance of toxicity, hence side-effects. Herbalists believe that all the phytochemicals from the whole plant are required to benefit your condition.
Post Treatment joint pains
Q I have had standard treatment for hep C genotype 3a, which was fortunately successful. I completed treatment almost two years ago. However I have been left with joint pain which is very severe at times. I have been referred to a rheumatologist who is testing me for all sorts of joint problems (including a form of psoriasis). He seems very knowlegable about hep C and says that both the virus and the treatment can trigger off rheumatic conditions (because of their effects on the immune system) in people who are predisposed to them .
My worry is that whatever condition he ultimately diagnoses is likely to require treatment with some quite powerful drugs (apart from pain killers) which themselves suppress/alter the immune system. The consultant was quite open about saying that the drugs are not ideal and can have significant side effects. What is your view and is there a herbal alternative capable of dealing with this level of joint problem.
A Congratulations for the successful treatment!
Yes hepatitis C and the conventional treatment for it are associated with various forms of arthritis and autoimmune conditions. I am sure that your rheumatologist is testing you for the rheumatoid factor and ANA (anti-nuclear-antibodies)to get to grips with what kind of condition you are affected by. Sometimes in chronic HEPC immune complexes (your antibody attacking antigen (i.e. virus) form which reside in your body, causing an auto-immune condition with related joint pains. This is due to an overexpression of cytokines triggering off an immune-response attacking your own joints. Conventional treatment will certainly alleviate the pain, however, it does not treat the cause of the disease, and often the side-effects are quite considerable, particurlarly in the long term.
Herbalists have quite an array of very good anti-inflammatories such as Devils' Claw and Feverfew, which are particurlarly good in treating joint pains. These herbs are taken internally. Herbalists also prescribe very good pain relieving creams, which increase the blood circulation in the affected area because they are warming, hence very helpful in joint pains. I am sure that a good herbalist would be able to prescribe you with a good range of herbal alternatives. In terms of food I suggest you avoid: citrus fruits, tomatoes, alcohol and red meat which are known to exacerbate joint problems.
Post Treatment physical and mental fatigue
Q I am 2 1/2 years post tx and clear of the virus after 23 years of infection. I have suffered since treatment with physical and mental fatigue (never had it before), compounded by little or no sleep (about 5 hours max per night and much of that is rarely continuous). I seem to be ok during the day despite this but at night my energy levels crash. I eat well and take care of myself pretty well but would be interested to know if there are key supplements, lotions or potions that you might recommend to combat this?
A Yes there are quite a few herbal remedies which counteract fatigue. However, please see a qualified herbalist, as a full medical history must be taken before prescribing you those, in order to rule out any interactions with other drugs/supplements you maybe taking or conditions you have/had.
Siberian Ginseng, Gingko biloba, Astragalus, Schizandra, Bilberry and Liquorice are some of the herbs which deal effectively with fatigue. However, the underlying cause of your fatigue should be diagnosed first before resorting to those herbs.
Itching driving me mad!
Q I was diagnosed two years ago with hepatitis C (don't know exactly how I contracted it). Since then, I Ihave been suffering from bad itching - specially on my feet and on the back of my legs. The itching comes only two or three days during the month so I suspect it might have a connection with hormones (I always seem to suffer from it in the days before my period). I just wonder if you could recommend anything to help alleviate the itchiness. It does drive me mad... Thank you very much!
A Itchy skin conditions are very common in hepatitis C and are associated with elevated levels of bile acids secondary to cholestasis (bile does not work properly!). I recommend you see a good herbalist and have your case history taken. This takes into account all your medications (i.e.) pill and other supplements you may take and rule out allergies. As a herbalist I work internally with the help of diuretics and blood purifiers and herbs in terms of bile metabolism. Externally you would definitely benefit from pure borage seed oil (which you will get from a good herbalist). The borage oil is applied after a bath/shower on your wet skin and left for a minute before towelling yourself dry.
Low Libido
Q My consultant is stumped and has no answer for this. Here is the problem. Many of us men experienced feminine type emotions during treatment on combination therapy. Mine have continued and I also very low libido. I have been tested for testosterone which is low but in the normal range. But what did show up was high prostaglandin which is a female hormone. This is the only female hormone they tested for so there may be others. Why is this happening? Why is my body producing female hormones? Will it settle down? My last dose of combo was back in October 2005. Is there anything I can do to reverse this either medicallly through my consultant/GP or with herbs?
A The treatment interferes with hormonal profiles and it appears that it has affected you quite a bit. I am not sure if your doctor did a whole hormone profile/panel? In case not I suggest you request this as it is important how all the hormones stand in relation to each other. It is not enough to judge on high prostaglandin and borderline testosterone levels alone. Once you have done your hormonal panel, you could see a qualified herbalist, as there are quite a few herbs which deal with hormonal imbalances and low libido in men and women. I am reluctant to give you any specific herb indication at this moment as I would need to see your hormonal profile first.
BTW, everybody produces both male and female hormones.
