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In This Issue:
Alan Franciscus, Editor-in-Chief
HealthWise: Choosing Not to Treat Hepatitis C
Lucinda Porter, RN
HCV & Native Americans
Alan Franciscus, Editor-in-Chief
HIV/HCV Coinfection Updates from the
International AIDS Society Conference
Blueberries, Asparagus and HCV
C.D. Mazoff, PhD
HCV Advocate Eblast
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—Alan Franciscus, Editor-in-Chief
Vibrio are a family of bacteria that can cause mild to severe disease in people. Included in this family of bacteria are Vibrio cholerae (cholera), Vibrio parahaemolyticus and Vibrio vulnificus.
The last Vibrio cholerae outbreak in the United States occurred in 1910-1911. In the last few years outbreaks of cholera have occurred in Iraq, India, Vietnam and some countries in Africa. Cholera is transmitted by ingesting fecal matter that contains the cholera bacterium.
A less severe form of Vibrio is V. parahaemolyticus that can cause gastroenteritis (abdominal cramps, frequent diarrhea, nausea and vomiting, headache, fever and chills). V. parahaemolyticus resolves after a few days and it does not usually cause serious disease. V. parahaemolyticus is transmitted by eating raw or undercooked shellfish, wading in or swallowing contaminated water.
Vibrio vulnificus or simply V. vulnificus is a common form of Vibrio that can cause serious illness and even death in certain populations. This article will focus on Vibrio vulnificus.
V. vulnificus infection is mostly seen in areas with warm coastal waters. According to the Centers for Disease Control more than 900 V. vulnificus infections were reported between 1988 and 2006 in the Gulf Coast states. In 2007, infection with V. vulnificus and other Vibrio bacteria became reportable illnesses in the entire United States.
Transmission of V. vulnificus occurs from eating raw or undercooked oysters, clams and other shellfish. A person with an open cut or wound who wades, swims in or swallows contaminated water can also become infected with V. vulnificus. Transmission of V. vulnificus occurs most often in the summer months when the bacteria in the salt water are at their highest levels. There are no cases of V. vulnificus being transmitted from person to person. It’s important to know that Vibrio is not caused by pollution, but rather from naturally occurring bacteria.
The initial symptoms of V. vulnificus usually occur within one day but can develop in 5 hours to 4 days and vary according to the type of infection. Symptoms and potential consequences include:
From eating raw or undercooked shellfish
Symptoms include watery diarrhea, stomach cramping, nausea or sick to the stomach, vomiting, fever, and chills. Severe gastrointestinal illness may require hospitalization especially in people with pre-existing liver disease or a compromised immune system (HIV positive, diabetes, cancer). Reports of people with hepatitis C dying from V. vulnificus are uncommon but do occur.
Exposure from an open cut or wound
Symptoms include fever, chills, decreased blood pressure, septic shock (major organ failure throughout the body), blistering skin legions or sores. In this type of infection immediate medical care is needed to prevent serious consequences. About 50% of people who contract this blood infection die.
Exposure from a skin infection*
Symptoms from skin lacerations or abrasions (scraped skin, etc.) include ulceration (open sores) that leads to dead skin tissue that may require surgical removal of the affected area or in severe cases amputation. Death can occur when the infection spreads to the bloodstream.
- Do not eat raw oysters or other raw shellfish.
- Cook shellfish (oysters, clams, mussels) thoroughly. Do not eat shellfish that do not open during cooking.
- Eat shellfish promptly after cooking and refrigerate leftovers immediately.
- Avoid cross-contamination of uncooked seafood, including seafood juices, with other foods.
- Avoid exposing an open cut, wound or broken skin in warm salt or brackish water, or to raw shellfish harvested from such waters.
- Wear protective clothing such as gloves when handling raw shellfish especially if hands have any open cuts or wounds.
Basic Food Handling Tips:
- Wash surfaces including cutting boards thoroughly between and after use.
- Always wash hands thoroughly with soapy water for at least 20 seconds before and after handling food.
- Never put raw food on the same cutting board or dish without cleaning thoroughly between use.
- Make sure food is cooked to the proper internal temperatures ***
- Do not leave any prepared or perishable foods at room temperature—make sure to refrigerate or freeze within two hours.
- Thaw food in the refrigerator.
- Dispose of any paper towels after use and wash any dish towels or sponges regularly to prevent cross-contamination.
If you suspect that you have been exposed to V. vulnificus seek immediate medical care. Aggressive treatment with antibiotics can help to prevent death or amputation of an infected limb.
*“Rare flesh-eating bacteria kills man after fishing trip.”
**Adapted from Centers for Disease Control:
***Food and Safety Inspection Service
For more information, please visit:
Centers for Disease Control:
Interstate Shellfish Sanitation Conference
Food and Safety Inspection Service
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HealthWise: Choosing Not to Treat Hepatitis C
—Lucinda K.Porter, RN
Imagine this scene. Your medical provider recommends treatment for chronic hepatitis C virus infection (HCV). You’ve had HCV for 30 years and your liver is moderately scarred. You have genotype 1 so treatment will likely last for 48 weeks. You have read about the side effects of the medications and, after careful consideration, you’d rather take your chances with hepatitis C than with the treatment.
Regular Healthwise readers probably think I am going to try to persuade this fictitious patient to reconsider. After all, if I didn’t believe in treatment I would not have tried it once, let alone twice. However, the decision to undergo treatment is a complicated one, and what worked for me might not work for others.
So, this month, I am headed in a different direction. I explore the other path—making the choice to not treat. I recommend ways to support your liver and general health. This advice applies to nearly everyone, but particularly those with liver disease.
There are many reasons for rejecting HCV treatment. Here are some:
- You are concerned that you might not be able to work.
- You are troubled by the potential side effects, particularly depression.
- You are bothered by the fact that the medication is given by self-injection and concerned it may trigger a relapse from drug recovery.
- You distrust the pharmaceutical industry and their products.
- You are committed to natural or alternative medicine.
- You are afraid that treatment will be unendurable.
- You are paralyzed by indecision.
- You are scared that the medication will harm, maim or kill.
- You favor waiting for better HCV medications.
- You are unwilling to go through treatment without better odds of success.
- You feel well and don’t want to give that up for a year.
- Your liver has little or no fibrosis and waiting makes sense.
- You think a sharp stick in the eye sounds like a better alternative.
Let’s assume you discussed all of this with your medical provider and your mind is made up. Now what?
First and foremost, minimize stress to your liver. Abstain from alcohol use. If you aren’t willing to quit, limit your drinking to no more than one standard size drink a day. One standard drink is 12 ounces of regular beer, 8 to 9 ounces of malt liquor, 5 ounces of table wine, or 1.5 ounces of 80–proof spirits. If drugs or alcohol are a problem, get help.
Keep your weight under control. Nonalcoholic fatty liver disease (NAFLD) is quickly becoming a serious health problem in this country. NAFLD is the most common cause of elevated liver enzymes. Tragically, NAFLD is striking children as well as adults. Complications from NAFLD include liver cancer and death.
Fortunately, NAFLD is treatable and potentially reversible. Weight loss is an effective treatment for NAFLD. Exercise may help. Patients with NAFLD showed improvement with as little as 60 minutes a week of low-to-moderate intensity exercise. Patients who exercised but did not lose weight also had significant improvements in fasting blood glucose, insulin resistance, and cholesterol and triglyceride levels.
Eat a low fat, high-fiber diet. Include fresh fruit, vegetables, and whole grains. Avoid trans-fatty acids, saturated fats, corn syrup and excess salt. Eat real food—rather than stuff out of a box.
Practice safe food habits. Avoid raw or undercooked shellfish. Raw or undercooked oysters and clams may carry Vibrio vulnificus—bacteria that cause a number of serious clinical conditions. Uncooked shellfish may also harbor hepatitis A.
Beware of poisonous mushrooms. They contain toxins that can destroy even the healthiest liver.
Do not eat wild mushrooms unless you are 100% sure of what you consume.
Aim for 30 or more minutes of exercise every day. If you are confused about exercise, here is a simple place to start. Put on comfortable walking shoes and sunscreen. Step outside and walk 15 minutes or more. Then turn around. Make this a daily goal. If 30 minutes is too much, start with something you can do. A walk to the mailbox is better than no walk.
Protect your liver from other viruses. If you aren’t already immune to hepatitis A and B, get vaccinated. Make sure all immunizations are up to date, including an annual flu shot.
Get regular check-ups. Your medical provider will recommend how often you should be seen and what labs and other diagnostic tests need to be performed. This all depends on the condition of your liver. Blood tests are usually done every six or twelve months, more frequently if you have cirrhosis. Medical appointments are usually scheduled annually, more often for patients with advanced liver disease. If you have cirrhosis, your provider may order an abdominal ultrasound every 6 months. Liver biopsies are usually recommended every 3 to 5 years. If you already have cirrhosis, there is no need to biopsy the liver.
If you use herbs or dietary supplements, learn how to do this safely. Some herbs are toxic to the liver. Large doses of any supplement are strongly discouraged. More is not better. Vitamin A in high doses can cause liver injury. Iron supplementation should only be taken under medical supervision. Herbs should never be used by people with decompensated cirrhosis. For more information about dietary supplements, visit www.hcvadvocate.org.
Act responsibly around blood and bodily fluids. This means not infecting others, and avoiding infections from others. Wash your hands. Practice safer sex. Cover all cuts or wounds. Do not share personal hygiene instruments, such as razors, cuticle scissors, nail clippers, toothbrushes or other items that might be exposed to blood. Properly discard all feminine hygiene products. Use good judgment when getting tattoos or body piercings.
Strive for the best health possible. If you smoke, try to quit. If you don’t floss your teeth, make this a daily goal. Wear your seat belts. Look for every opportunity for improvement. If you hear yourself groaning about this, consider an attitude adjustment. We don’t have to improve our health—we can take chances. Alternatively, we can take our future into our own hands and start feeling better now.
Keep abreast of medical news. Science is making giant leaps. The Hepatitis C Support Project provides the latest news on liver disease. You can subscribe to regular updates or go to www.hcvadvocate.org. At this website, there is an extensive list of HCV and other liver-related drugs that are in various stages of development.
Finally, think about others. Although you cannot donate blood to a blood bank, you may donate your organs and tissues after death. To register, visit www.donatelife.net The Harvard Brain Bank would love your brain. www.brainbank.mclean.org 1-800-BRAIN BANK (1-800-272-4622) Consider giving this ultimate gift.
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HCV & Native Americans
—Alan Franciscus, Editor-in-Chief
While conducting a training workshop in Aberdeen, South Dakota in cooperation with the Indian Health Services, a workshop participant gave a short overview of the epidemiology of HCV in the native American population based on a study conducted by Amy S. Neumeister, MD, and colleagues that appeared in Journal of the National Medical Association titled “Hepatitis-C Prevalence in an Urban Native-American Clinic: A Prospective Screening Study.” Since there is very little data on HCV in the native American population I was very excited to be able to write up this information and share it with our readers.
The study was conducted in Omaha, NE at the Fred LeRoy Health and Wellness Center. A total of two hundred and forty-three native Americans were screened (161 females; 82 males). The mean age was 41 ± 1 yo. Over 30 tribes from across the United States were seen at the clinic and represented in the study. The majority of the participants lived in an urban environment—only seven participants (2.9%) lived on an Indian reservation. The participants were also asked to fill out a risk factor assessment.
The study participants were screened for HCV antibodies and a follow-up HCV RNA (viral load) test was performed to confirm active HCV infection. If a participant received an HCV RNA positive result a one-on-one counseling session with a physician to discuss the possible consequences of HCV was offered, as well as treatment options and counseling on the importance of avoiding alcohol. A referral to a hepatologist for further monitoring and possible treatment was also offered.
The overall results showed that there was an HCV antibody positive rate of 11.5% (8.1% females; 18.3% males) and the HCV RNA results were reported at 8.6% (6.2% females; 13.4% males). All the participants who tested HCV RNA positive were between the age of 30 to 59 years old (30-39 (13.3%); 40-49 (12.0%); 50-59 (14.3%).
Injection drug use was the number one risk factor followed by receiving a tattoo more than 5 years ago, having sex with an HCV positive person, alcoholism, any transfusion, any tattoo and receiving a blood transfusion before 1992.
Note: these were self-reported risk factors or behaviors. Alcoholism is an association, but it is important to know that a person can not get hepatitis C from drinking alcohol.
Importantly, participation in a Sun Dance ritual was not a significant factor. The Sun Dance ritual is a Sioux ceremony that is practiced by many Great Plains Indians. It includes “flesh offerings,” where 1 or more incisions are made into the skin in those participating in the ceremony. In the past, one knife was used, but now tribal-sponsored ceremonies use only sterile, surgical scalpels.
The study is an ongoing study where more data will be collected. The authors also stated that more studies are needed in larger native American populations. The purpose of these future studies will be to:
- Confirm the findings in the present study of the risk of acquiring HCV by receiving a tattoo.
- Assess the prevalence of HCV in native Americans living on reservations.
- Improve the level of HCV education.
- Collect information on genotype.
- Understand the response to HCV treatment in native Americans.
A special thank you to Lora L. Langley, RN, BSN for providing a short overview of the study and providing participants with a copy of the journal article.
A.S. Neumeister, et al. Hepatitis-C Prevalence in an Urban Native-American Clinic: A Prospective Screening Study. Journal of the National medical Association, vol. 99, no.4.
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Understanding HCV: A Patient Pocket Guide by Alan Franciscus
This pocket guide is designed to help you make informed choices about various aspects of living with hepatitis C. Starting with basic information about hepatitis C prevention, disease progression and management, this booklet goes on to provide you with the tools you need to advocate for the best possible medical care and treatment.
You can download this guide and other educational materials at: www.hcvadvocate.org/hepatitis/materials.asp
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HIV/HCV Coinfection Updates from the International AIDS Society Conference
Several studies looking at hepatitis C virus (HCV) coinfection in people with HIV were presented at the 5th International AIDS Society Conference on HIV Pathogenesis, Treatment, and Prevention (IAS 2009), held July 19-22 in Cape Town, South Africa.
Unlike most HIV conferences over the past few years, IAS 2009 featured only one oral abstract on HIV/HCV coinfection, rather than the usual dedicated abstract session. Notably, no new information was presented about ongoing outbreaks of apparently sexually transmitted HCV among HIV positive gay men in Europe and the U.S. It remains to be seen whether this was a one-time aberration or the beginning of a trend in the HIV field.
Below is a review of several HIV/HCV coinfection studies, mostly presented as posters. For the conference program and abstracts, along with selected slide presentations and posters, see www.ias2009.org/pag.
In the sole oral presentation, P. Marti-Belda reported that HIV/HCV coinfected patients who achieve sustained virological response (SVR) to pegylated interferon plus ribavirin may experience liver fibrosis regression (abstract WEAB105).
Spanish investigators used the noninvasive transient elastometry (Fibroscan®) method to assess fibrosis in coinfected patients who received pegylated interferon alfa-2a (Pegasys) or alfa-2b (PegIntron) plus 800-1200 mg/day weight-adjusted ribavirin for 48 weeks. Most participants (80%) were men, the mean age was 41 years, half had HCV genotype 1, about one-third had genotype 3, about half had mild-to-moderate fibrosis at baseline, and 23% had evidence of cirrhosis. Overall, patients had well-controlled HIV disease with an average CD4 cell count of about 500.
Among 294 participants in the main treatment trial, 171 underwent liver biopsy before treatment, 157 of these were assessed with Fibroscan® during follow-up (median 44 months after treatment), and 96 received a second Fibroscan® (on average eight months after the first). Fibrosis regression was defined as a decrease of at least 1 point.
Overall, 43% of participants achieved SVR six months after completing treatment. During follow-up, 28% experienced fibrosis regression, 35% had stable fibrosis, and 37% experienced fibrosis progression. Sustained responders were significantly more likely to experience regression, with 38% having at least a 1-point decrease in fibrosis score and 24% having at least a 2-point decrease. Among nonresponders, the corresponding rates were 22% and 6%, respectively. Some participants with advanced liver disease at baseline experienced reversal of cirrhosis; this was more likely among sustained responders (44% with a 1-point decrease and 33% with a 2-point decrease) than nonresponders (23% and 18%, respectively). Patients who underwent a second Fibroscan® had even better outcomes, indicating continued improvement over time.
After adjusting for confounding factors, SVR was the only significant predictor of fibrosis regression. “Our study demonstrates fibrosis improvement after HCV therapy in an important proportion of HCV/HIV patients,” the investigators concluded. These findings, they suggested, support expanded hepatitis C treatment for coinfected patients and development of future therapies that promote fibrosis regression as well as viral eradication.
Role of Glucose
In another Spanish study, J.V. Fernández Montero and colleagues used Fibroscan® to estimate changes in fibrosis in a prospective cohort of HIV positive participants (abstract WEPEB218). Again, most were men, the median age was 45 years, and the median CD4 count was 494. Nearly three-quarters (72%) were coinfected with HCV, 10% were coinfected with hepatitis B virus (HBV), and 9% were heavy alcohol users.
A total of 632 participants received two Fibroscan® assessments, the first at least four years after study enrollment and the second at least 18 months (median 27 months) later. Fibrosis regression was defined as a decrease of at least 30% in “liver stiffness” among patients with advanced fibrosis or cirrhosis (Metavir stage F3-F4, indicated by a stiffness measurement > 9.2 kPa).
On the first Fibroscan®, 30% of participants had stage F3-F4 liver fibrosis, and on the second, 10% met the criteria for fibrosis regression. In a single-factor analysis, patients who experienced regression were significantly more likely to be female (84% vs. 68%) and to have received hepatitis C therapy (81% vs. 44%). Patients with fibrosis regression also had a significantly larger decrease in blood glucose between Fibroscans (-3.2 vs. +1.9 mg/dL) and lower HIV RNA levels at the time of the second scan (1.8 vs 2.1 log). In a multivariate analysis, however, the only factors significantly associated with fibrosis regression were hepatitis C treatment and – to a lesser extent – improved blood glucose levels. These findings suggest that people who improve glycemic control (e.g., with dietary changes or medications) along with hepatitis C treatment may achieve better outcomes.
Double-Dose Pegylated Interferon
Because HIV/HCV coinfected patients do not respond as well to interferon-based therapy as those with hepatitis C alone, researchers have explored intensified treatment using higher drug doses for extended durations. F. Gatti and colleagues from Italy evaluated the safety and efficacy of a high-dose pegylated interferon induction regimen with a four-week ribavirin lead-in phase (abstract WEPEB223).
This small pilot study included 16 patients with HCV genotypes 1 or 4 and advanced fibrosis or cirrhosis (Metavir F3 on liver biopsy or > 12 kPa by Fibroscan®). All participants initially received 14-17 mg/kg/day weight-adjusted ribavirin for a four-week lead-in period. They then added double-dose pegylated interferon (360 mcg/week Pegasys or 3 mcg/kg/week PegIntron) for the next 12 weeks, and finally reduced to a standard dose (180 mcg/week Pegasys or 1.5 mcg/kg/week PegIntron) for the remaining 36 weeks. Response rates were compared against those of 28 patients at the same center treated with standard therapy for 48 weeks.
After four weeks of combination therapy, more than twice as many patients in the high-dose induction group achieved rapid virological response (RVR; undetectable HCV RNA) compared with the standard therapy group (19% vs. 7%, respectively). At week 12 (the end of the induction phase), partial early virological response (EVR) rates were similar in the two groups (50% vs. 54%, respectively), but complete EVR rates showed the same pattern as RVR (19% vs. 8%). Among participants with adequate data to determine sustained response 24 weeks after completion of therapy, SVR rates were equal, 7% in both groups. Given the small number of participants, none of the differences reached statistical significance.
Treatment discontinuation rates were very high. All 16 patients in the high-dose induction group discontinued therapy early (13 due to poor response, 3 due to adverse events), as did 22 patients in the standard therapy group (16 due to poor response, 6 due to adverse events). The researchers concluded that ribavirin pre-treatment and high-dose pegylated interferon induction resulted in a “disappointing short-term outcome” in difficult-to-treat coinfected patients.
M. Vogel and colleagues from Germany (abstract WEPEB235) conducted a prospective, partially randomized study comparing hepatitis C treatment outcomes among 60 HIV negative individuals, 46 HIV positive patients not on combination antiretroviral therapy (ART), and 68 HIV positive patients on ART; about 60% had HCV genotypes 1 or 4. Those in the third group were randomly assigned to take either an ART regimen without nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) or a standard regimen consisting of 2 NRTIs plus a non-nucleoside reverse transcriptase inhibitor or protease inhibitor.
Patients were initially treated with 180 mcg/week Pegasys plus 800 mg/day ribavirin for 24 weeks if they had HCV genotypes 2 or 3, or 48 weeks if they had genotypes 1 or 4. The protocol was later amended to also treat genotype 2 or 3 patients for 48 weeks (as per current coinfection guidelines) and to increase the ribavirin dose for those with genotypes 1 or 4.
In contrast with most prior studies, SVR rates were comparable between HIV positive and HIV negative patients, both at 54%. Likewise, sustained response rates did not differ significantly between HIV positive patients receiving or not receiving ART (59% vs. 52%, respectively). There was, however, a significant difference between patients receiving NRTI-free and NRTI-containing ART regimens (75% vs. 42%, respectively). In a post-hoc analysis, low baseline HCV RNA, genotype 2 or 3, and not using abacavir (Ziagen, also in the Epzicom combination pill) were independent predictors of SVR. Looking just at genotype 1 or 4 patients who received weight-adjusted ribavirin, however, only baseline HCV RNA remained a significant predictor. The higher response rate associated with NRTI-free ART, the researchers suggested, “was most likely due to use of abacavir in patients with low doses of ribavirin.”
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Blueberries, Asparagus and HCV
—C.D. Mazoff, PhD
Being a lover of blueberries and asparagus, the recent news articles about research done on blueberries and HCV and asparagus and liver toxicity not only got my interest but also perked up my appetite!
I’ll eat as many blueberries as I can when they are in season – in smoothies, with ice cream, on my morning granola or cornflakes, or whatever. I always knew that blueberries were good antioxidants, but I didn’t know that an extract from the leaves has been shown to be a powerful agent against HCV.
Findings published in a recent article in the Journal of Biological Chemistry, by Masahiko Takeshita et al. of the University of Miyazaki “suggest that proanthocyanidin isolated from blueberry leaves may have potential usefulness as an anti-HCV compound by inhibiting viral replication,” thus slowing or stopping disease progression.1
The researchers screened nearly 300 different agricultural products for potential compounds that suppress HCV replication and found one in the leaves of blueberries. The researchers purified the compound and identified it as proanthocyanidin, a polyphenol similar to the beneficial chemicals found in grapes. Okay, I eat grapes too. Double yum.
Apparently the blueberry extract found to be most effective comes from a type of blueberry found in the South eastern USA: Rabbit eye blueberries (Vaccinium ashei).
A quick look on the internet showed me that Rabbit eye blueberries have been used in Food research for some time, but they are not the type used in blueberry extracts found in most health food stores – I checked. Hmmmm???
I did find this, however: “The common blueberry is an abundant source of several potent antioxidants, particularly Anthocyanin and related compounds. Clinical studies have shown that Anthocyanin neutralizes free radicals which are specific to age-related mental clarity and memory capacity. This particular family of antioxidants has also been proven effective in fighting the free radicals responsible for macular degeneration and other age-related eye disorders. A 2001 study at Tufts University rated blueberries as the most potent antioxidant of over 60 foods tested (Tufts University. Researching a Blueberry/Brain Power Connection. TuftsUniversity Health and Nutrition Letter, March 2001, Vol. 19. Number 1)”.2
Further investigation showed me that what blueberries do is lower cholesterol and other lipids, like triglycerides.
In fact research done at Saga University in Japan and published in 2008, showed that Vaccinium ashei had a startling efficacy in lowering hepatic lipids in rats.3
But nowhere could I find out where to get this extract, or how the extract is made, or if eating more blueberries would produce a similar effect. Bummer.
Just when I thought things couldn’t get better, along comes this news item about an article on Asparagus published in the Journal of Food Science saying that “an extract from asparagus may increase the function of enzymes in the liver and boost the metabolism of alcohol.” The researchers from Korea concluded that “the leaves of A. officinalis, which are normally discarded, have the potential for use in therapy designed to protect the liver from various harmful insults.” Sadly, again, no extract recipe.
Asparagus has long been used as an herbal medicine in Asia thanks to its anticancer effects. It also has antifungal, anti-inflammatory and diuretic properties, and its health properties probably result from its high levels of folate and potassium, and Vitamin C. Green asparagus contains approximately six times the levels of Vitamin C than citrus fruits. (http://food-facts.suite101.com)
Okay…but where do I find this stuff, and how do I make sure that it’s what it says it is, and how much do I take, and what are the side effects if any. All this worry is making me hungry.
I’ve got an idea. While I’m waiting for more information, I think I’ll make myself some grilled wild salmon with blueberry sauce, have lots of asparagus on the side, and worry about it tomorrow. Because the way it seems to me is that lowering serum lipids and boosting glucose tolerance is the best thing I can do for my liver in the meantime, and that I can control my health for now with my diet.
1“Proanthocyanidin from Blueberry Leaves Suppresses Expression of Subgenomic Hepatitis C Virus RNA,” J. Biol. Chem., Vol. 284, Issue 32, 21165-21176, August 7, 2009
3Effect of Vaccinium ashei reade Leaves on Lipid Metabolism in Otsuka Long-Evans Tokushima Fatty Rats. Koji NAGAO1, et al. Saga University. Bioscience, Biotechnology, and Biochemistry Vol. 72 (2008) , No. 6 pp.1619-1622.
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