Saturday, March 18, 2017

Could maintaining a healthy weight actually improve liver health in a person with HCV?

Could maintaining a healthy weight actually improve liver health in a person with HCV?
Studies indicate that obesity and diabetes can accelerate damage caused by the hepatitis C virus, with research pointing to an increased prevalence of diabetes in people with HCV.

HCV is associated with a broad range of conditions other than liver disease and are thought to include (but are not limited to) fatigue, depression, cryoglobulinemic vasculitis, renal disease with or without cryoglobulinemia, skin disorders including cutaneous leukocytoclastic vasculitis and porphyria cutanea tarda, lymphomas, diabetes mellitus and metabolic syndrome.

Type 2 Diabetes
The latter two, diabetes mellitus and metabolic syndrome are both detailed in a review article by Mitchell L. Shiffman, MD published in Liver International. The good doctor cited metabolic complications associated with the virus; insulin resistance and type 2 diabetes as an indication for treatment. Although, in the article, Dr. Shiffman set out to inform private insurance carriers and governmental healthcare agencies of the importance, and need to cover effective medications to treat the hepatitis C virus, the information is extremely patient friendly, one you may want read or pass along.

He wrote:
At the very least the presence of the metabolic syndrome, insulin resistance or  type 2 diabetes mellitus should be an indication for HCV therapy for all private insurance carriers and governmental healthcare agencies.
Below is the abstract, full text article here.

Chronic hepatitis C virus (HCV) is associated with insulin resistance (IR) and leads to type 2 diabetes mellitus (T2DM) and hepatic steatosis in many patients. These metabolic complications of HCV have been shown to accelerate the progression of fibrosis to cirrhosis and increase the risk of hepatocellular carcinoma. The metabolic syndrome is a common disorder that also includes IR, T2DM and hepatic steatosis. Approximately 20%-30% of patients with chronic HCV also have co-existent metabolic syndrome. The cause of steatosis in patients with the features of both the metabolic syndrome and chronic HCV is sometime difficult to determine. Patients with metabolic syndrome and chronic HCV are also at risk of developing renal, cardiovascular and cerebrovascular disease. Recent data suggest that HCV is an independent risk factor for renal, coronary and cerebral vascular disease, and may increase mortality associated with these disorders. The treatment of HCV can now result in a sustained virological response and cure nearly all patients with chronic HCV. The eradication of HCV reduces the risk of developing IR and T2DM, improves IR and 2TDM, reduces the risk of developing chronic kidney disease, end-stage renal disease, acute cardiac syndrome and stroke in patients with 2TDM. Thus, treatment of chronic HCV can provide a significant public health benefit, but only if all patients with chronic HCV are identified and universally treated.
I highly suggest you read the full text article.

Eating Right To Control Type 2 Diabetes
Today, I found an interesting article over at PMlive, about a study published in the Journal of Clinical Endocrinology & Metabolism, which found 40% of patients with type 2 diabetes who underwent a lifestyle change including exercise and diet were able to stop taking their medications, and were left without any signs and symptoms of diabetes.
The team from McMaster University in Canada tested the idea in diabetic patients who had been symptomatic for up to three years, underwent a personalised exercise regimen, a diet reducing their calorie intake by 500 to 750 per day and continued use of glucose-controlling drugs (metformin, acarbose and in some cases basal insulin) to closely manage blood sugar levels. 
After four months 40% (11 of 27) of patients who adhered to the changes were able to cease taking their medications and stay in complete or partial remission from diabetes according to investigator Natalia McInnes.
Here is the article.

Liver Cancer, Type 2 Diabetes
In the March 2017 issue of Gut, a recent study investigated the link between high body mass index in late adolescent men, reporting it was associated with an increased risk of future severe liver disease, including HCC (liver cancer). The overweight men were more likely to develop liver disease later in life by almost 50% - than men of a normal weight. In addition the development of Type 2 diabetes during follow-up was associated with a further increased risk of severe liver disease, independent of baseline BMI. The authors call for earlier interventions and additional screening for those at risk.
Here is the article.

HCV Diet And Exercise
Although the above mentioned articles did not include people with HCV, a 2013 study published in Nutrition, found HCV patients who participated in a diet and exercise program lowered their grade of steatosis and remarkably their fibrosis score.
The present study establishes the benefits of the low-calorie diet and low-fat diet in management of patients with hepatitis C regarding improvement of insulin resistance, steatosis and also liver fibrosis. 
Overweight or obese patients with hepatitis C undergoing a lifestyle intervention (specific dietary intervention and physical activity) for 1-year had significant improvements in body weight, lipid and hepatic profiles.
Read the article here.

Off The Cuff

Published in Gastroenterol Hepatol (N Y). 2014 Jan; 10(1): 43–45.
Fibrosis and Cirrhosis in HCV Infection
An interview with Mitchell L Shiftman, MD

Gastroenterology & Hepatology: What are your thoughts about vitamin supplementation on fibrosis and risk of cirrhosis?

Mitchell L Shiftman, MD: The data are very mixed and not conclusive. The strongest data, which are consistent but sparse, suggest that vitamin E may reduce the fat content in patients with fatty liver disease. This, in turn, may reduce fibrosis progression. At this stage of the game, eating healthy and maintaining health is probably a better strategy for averting liver fibrosis than vitamin supplementation. Interestingly, the strongest data about the antifibrotic effects of food concern coffee. Data from several studies now suggest that drinking 2 cups of coffee a day reduces fibrosis progression in the liver. The most useful study on this comes from the National Institutes of Health HALT-C (Hepatitis C Antiviral Long-term Treatment against Cirrhosis) trial. Patients completed detailed diet questionnaires that included questions on coffee and tea consumption. A strong relationship between coffee consumption and lack of cirrhosis was found.

Read the 2014 interview here....

The bottom line
Experts agree, exercise, eating healthy, and controlling weight gain are all key elements in the management of HCV, especially for those people with both hepatitis C and type 2 diabetes.

Recommended Reading
Current level of evidence on causal association between hepatitis C virus and type 2 diabetes: A review
2017 - Management of extrahepatic manifestations of chronic hepatitis C virus infection
HCV - Fatty liver disease and genotype 3
The Liver Loving Diet 

Have a great weekend!

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