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An introduction to basic supplements

Making sure you are eating a good diet which includes all the necessary vitamin and minerals is essential. But taking additional supplements may also be a good idea for some people with hepatitis C. You may have a deficiency or find it hard to absorb enough of the right nutrition from food you eat because of digestive problems. The best thing to do is to try taking them and see if they make you feel any better, but bear in mind that the changes can be very subtle and take time to have an effect.

There is a mass of very conflicting information about supplements and hepatitis C especially on the internet, with reports of people taking massive doses of some things. Be cautious about taking supplements as a lot depends on factors specific to each person’s state of health, extent of liver damage and the strength or weakness of other organs and other health issues. It is always a good idea to discuss it with a health practitioner you trust if you are thinking of taking supplements. The information included here is about relatively safe supplements that many people with hepatitis C have tried. But always bear in mind that it is an individual affair and don’t take mega doses as they can be extremely harmful to the liver (see cautions below).

If you do decide to take additional supplements it is very important to take good quality ones. Look for brands that have the least amount of fillers and added ingredients. Good quality brands include Biocare, Solgar, Veridian, Vega, and Cytoplan* who make very good food-state supplements.

Antioxidants

Antioxidants are essential in slowing down the progression of liver damage (fibrosis) by neutralizing dangerous free radicals. Free radicals are highly reactive chemical substances which are the by-product of our cell’s normal chemical reactions, such as energy generation and the breakdown of fats. During these reactions oxygen is transformed into the free radical superoxide which can cause cell and tissue damage. Normally there is a mechanism for protecting cells from the dangers of free radicals, but if there are too many free radicals to deal with then there is a risk of cell damage. Free radicals are of concern for people with hepatitis C for several reasons.

  • Chronic liver inflammation may lead to overproduction of free radicals within the liver.
  • There is evidence that free radicals play a role in liver fibrosis. Free radicals can chemically alter fat in the body. This is called lipid peroxidation. The free radicals attack the cell membrane and can injure and eventually kill cells. If this happens in liver cells it can lead to more scarring or fibrosis.

If the liver function is already impaired and this has led to an overload of iron then the free radicals may interact with the iron causing further damage.

Which Antioxidants?

  • Vitamin C is a very easily available and powerful antioxidant. It is recommended to take 500mg a day. If you want to take more, it is better to take 500mg twice a day rather than 1gm once a day. Vitamin C is not stored in the body and any excess will be excreted.
  • Vitamin E is another powerful antioxidant that is used to combat fatigue, help the skin and support the immune system. It is recommended to take between 200-400 IU per day (IU are the units of measurement it is sold in – it stands for International Units).
  • Alpha Lipoic Acid helps support liver metabolism and purge heavy metals from the body. Stores of ALA drop as you get older so you may want to include it as a supplement. It also enhances the functioning of the antioxidants vitamin C and E and glutathione (which plays an important role in detoxification and a healthy immune response).
  • Zinc, Selenium and Milk Thistle are also antioxidants
    You can buy many different antioxidant formulas which include a few together. Avoid ones that include vitamin A as it is stored in the liver.

Gingko

Gingko is thought to be very helpful for brain and memory function, and for people with hepatitis C it can be helpful for brain-fog and cognitive disturbances. It is also an antioxidant and may act as an anti-inflammatory and anti-viral as well. It only starts to work after taking it for 4 weeks or more and for some people it may take up to 12 weeks to have an effect. Gingko thins the blood so it is not suitable for people who take aspirin, warfarin or other anticoagulants.

Lecithin

This helps to break down fat and speed up the flow of fats through the liver. It also helps prevent the build up of fats within the liver and assists the liver in detoxifying. Lecithin contains choline (which helps mental function) and inositol (which helps support liver function). Supplements are derived from soya and usually come as granules. You can buy them in most health food stores and some chemists.

Milk Thistle

Has been used for centuries as a liver protecting herb and is the most common supplement taken by people with hepatitis C. It increases the liver's production of antioxidants. It is also thought to protect the liver from damage, help it repair damage, and generally improve liver health. It is also thought to support the immune system and act as a mild antidepressant. It also stimulates the production of bile. It is available as a supplement in tablet or capsule form. Take standardised capsules or tablets of 200mg 2 or 3 times a day. Choose one with the least amount of fillers and additives, from a reliable source. N.B you are unlikely to feel any effect with milk thistle, but that doesn’t mean that its liver protecting qualities are not working.

Multivitamin and multiminerals

These can be an easy way to make sure you are getting enough vitamins in your system. It’s very important to make sure the formula does not have iron in (unless you are anaemic - see Iron below). Also make sure it is not high in vitamin A (as it is stored in the liver) and that the vitamin A it does contain is in the form of beta-carotene.

Probiotics

Probiotics are living bacteria that encourage the growth of friendly bacteria (flora) in the intestines. The right balance of intestinal flora is essential for good bowel health and for fighting disease. The virus can cause many digestive problems and symptoms such as bloating, gas, IBS, discomfort after eating, sensitivity to many foods. If you do experience any of these symptoms then it’s a good idea to try and take care of your bowel health as this has a big effect on the absorption of vitamins and minerals. A problem with the bowels creates more detoxifying work for the liver, which contributes to further symptoms.

Probiotics come in capsule or powder form and need to be stored in the fridge as they are alive. Choose ones that include a high amount of live acidophilus and bifidus. Good brands to look out for are Biocare, Nutri and Higher Nature*. In the section on herbs you will find information about herbs to help digestive problems.

Selenium

Selenium is a very important mineral. It is an antioxidant, maintains levels of glutathione in the body and is vital in the maintenance of immune function. It is thought to prevent tumour development, and has been found to protect the liver. It may support thyroid function and may possibly help in reducing viral replication in hep C and viral load. See the vitamins and diet sheet to ensure you get enough in your diet. People we have spoken to have found Immunova’s* zinc, selenium and magnesium products very helpful, as they come in liquid that is easily assimilated, but start with the lowest dose as some people are very sensitive to them. Selenium is toxic at high doses so be careful with amounts.

Vitamin B

The vitamin B Group is ESSENTIAL for liver health, especially for its detoxification system. If you feel you are not getting enough vitamin B from your diet, it can help to take a B complex supplement. Don’t take any of the B vitamins as a separate supplement as they work best when taken together. In general, a vitamin B deficiency can cause, fatigue, depression, emotional problems, low energy, susceptibility to stress and skin problems. Smoking and stress deplete the body of vitamin B

When you choose a supplement make sure it has B12 in it. Try to get one with no more than 50mg of niacin (B3), as in high doses it can encourage liver damage. Also check to see if it contains inositol and choline, which helps the B vitamins transform energy into a usable form for the cells.

Zinc

Zinc is very important as it strengthens the immune system. People with hepatitis C are often lacking in zinc. It plays a major role in the functioning of numerous different enzymes. It is also an antioxidant. It is essential for the nervous system and immune system. It is thought to act as an antiviral agent for the herpes virus. It prevents an over-accumulation of vitamin A in the liver – too much vitamin A can cause problems for the liver. Immunova* make a good source of liquid zinc.

Dosages

  • Always read the label on the bottle.
  • It is best not to take higher than the recommended doses of vitamins and minerals as they can be toxic to the liver. This is especially important if you have liver damage (fibrosis or cirrhosis) as the vitamins have to be processed by the liver.
  • For example it’s better to take 500mg of vitamin C twice a day rather than 1000 mg once a day.

Cautions

It is best to avoid iron in multivitamins unless your doctor specifically recommends it because you are anaemic. High levels of iron cause more liver damage and increase the risk of cancer. Ask your GP or liver clinic for a test to find out what your iron levels are – you need to know if you are anaemic or if you have high levels of iron in your blood. Also it is important not to take high doses of vitamin C if you have high iron levels as it helps the uptake of iron in the body. Too much folic acid inhibits the absorption of zinc. Selenium is toxic at high levels.

*Any brands we suggest come from the recommendations of people with hepatitis C who have used them and we have spoken to. The Trust has no allegiance with any company or brands, we just feel that if you are going to spend money on supplements, it’s good to buy the most reliable sources.