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Tuesday, 28 August 2012

The Origins of the High-Fat Hep C Diet

The other day I rediscovered one of my early posts about my concept of a high fat diet for Hep C.
It was posted on the Life Extension Foundation forum on 27 Feb 2011.

I started restricting carbs after reading "Protein Power" by Michael and Mary Eades, where the rationale for reducing inflammation by restricting carbs and eating more fats is spelled out.
This was good, but it wasn't till I read "Dr Atkin's New Diet Revolution" that I saw the link between what happens to VLDL/TG on ketogenic diets, and what HCV does to exploit lipids.
Next, I found out about the Nanji-French research that demostrates a liver-protective role for saturated fat, and tried limiting PUFA.
Then (about October 2010) I started to get the results I wanted and was ready to write about it, so I posted about it on MySpace (remember MySpace? Tom you bastard, I want my customized settings back!) then posted this at LEF (to date there have been no responses).

the HCV virus
is linked exclusively to lipid metabolism (blood fats, commonly but
erroneously called "cholesterol").

- HCV virion is completed by enzyme DGAT, which also packages fats
(triglycerides) prepared by the liver.

- HCV virion escapes infected liver cells via VLDL-c expression.
VLDL-c (very low density lipoprotein cholesterol) carries fats made by
the liver to cells that need them, also carries cholesterol and
lecithins made by the liver.

- HCV virion enters uninfected liver cells via LDL-c receptor. LDL-c
is remains of VLDL-c after fats have been delivered. The fewer
triglycerides, the larger the VLDL-c and LDL-c, hence the fewer interactions there will be with receptors.

This is why HCV only infects the liver - only hepatocytes have all of
these enzymes and receptors.

Now, where do triglycerides and VLDL-c come from? Over half comes from
the carbohydrate in the modern high-carbohydrate diet, converted to
fats for storage or energy, and this half is not produced at all on
high-fat diets.
In other words, on a high-fat, very-low-carb diet, serum levels of
triglycerides (FAT = Fatty Acid Triglycerides) and VLDL-c are
approximately 50% of the levels seen on a low-fat diet.
This diet should automatically reduce the HCV viral load by a similar
amount and the reduction should continue over time. Because the LDL-c
receptor is upregulated on the high-fat diet, probably increasing
uptake of HCV (yet the LDL-c are larger, so there are even fewer of them) the effect is not quite as clear-cut as that, but the trend is definitely downward (we need someone with math skills to
design a mathematical model for this).

[note: I don't think today that the LDL-C receptor will be upregulated so much, if at all, if the diet is high in cholesterol and restricted in PUFA]
Further, on a high-fat diet there is also a very significant drop in
pro-inflammatory cytokines involved in liver fibrosis and autoimmunity
(which are connected to and driven by insulin) - see Volek
There are other benefits too: the food being nutrient dense puts less
work on the gut, and extracting energy from fats requires fewer
vitamins and minerals compared to carbohydrate metabolism. Oxidising a
long-chain saturated fat to ATP involves the same reaction over and
over, which is economical, whereas oxidising glucose involves a
different reaction at each step. This is why refined carbohydrates and
foods high in sugar and starch cause vitamin and mineral deficiencies,
while meat contains all the nutrients needed to process the fats it

Further, diets high in highly saturated fats such as coconut oil, palm oil, and beef tallow are able to reverse liver fibrosis (Mezey, also Nanji, while high-PUFA vegetable oils promote liver damage in inflammatory conditions. DHA and lecithin are exceptions to this rule.

The ideal diet for Hep C, according to this hypothesis (and borne out by my experience over the past year) is a diet rich in animal protein and animal fat, with some fish but mostly red meat and eggs, in which most carbs come from green, leafy vegetables. Coconut and coconut cream are used with fish, and grains are completely avoided, as are all sugars except dark honey, fruit juice except small amounts of pomegranate, legumes are restricted to small infrequent servings, all potato is replaced with small servings of sweet potato and pumpkin. Food that needs fat is cooked in beef tallow or butter. Cold pressed virgin olive oil and sm all amounts of sesame seed oil are the only liquid oils used. Nuts and seeds are eaten occasionally. Berries are the main fruit, with small amounts of apple, mango, and apricot  [I have no idea now why these particular fruits were my exceptions to the no-fructose rule. Today I'd prefer citrus, and the occasional banana]. Spices are used often; cheese and yoghurt are preffered to milk and milk solids.

As for the objection that this diet may elevate cholesterol, high cholesterol levels in Hep C are associated with less fibrosis and a better response to interferon-ribavirin. This is a diet that elevates HDL-c and lowers triglycerides, which are better proxy markers than cholesterol alone.

Antioxidant supplements including Co-Q10, selenium, tocopherols, zinc, ascorbate, grape seed extract, plus krill oil or cod liver oil and vitamin D3 are taken.

Also, supplements supplying 400mg calcium and 150mg magnesium are taken with each meal of meat or high-iron vegetables to significantly reduce iron uptake.

Glucosamine and niacinamide, plus B12 and folate are used to promote normal iron metabolism and erythropoesis if necessary.

This hypothesis first published (c) 2010 by George D. Henderson, Huia, Auckland, New Zealand

While looking for this, I also found the Atkins website recommendations for Hepatitis. These are pretty much the supplements I used to take, some of which I still use.
FYI, here is my current supplement regime:

100mg co-enzyme Q10

120mg Enzogenol pine bark extract (or 200mg grape seed extract) 

4mg astaxanthin

Lactobaccilus rhamnosus and bifidus probiotic

Magnesium (as CMD) with salt

Vitamin D (10,000 iu 2x weekly)

Vitamin K2 (MK7) 90mcg daily

vitamin E 130iu (in above supps, or I probably wouldn't bother)

vitamin C 60mg (ditto, but I'd take 500mg 2x daily if I had it)

I also eat some brazil nuts every day for extra selenium, and eat liver regularly for retinol, copper, etc.

What do I do in my spare time? This.

Thanks for reading this blog so patiently and critically, now it's time to relax and enjoy a song: "Secret Holiday" by The Puddle.


majkinetor said...

I think you are totally off the mark regarding Vitamin C. 60mg isn't supplementation worth mentioning.

Here is something to get you started in the right direction:

My knowledge of vitamin C is very extensive, if you need any help with dosage just ask.

Puddleg said...

The 60mg just happens to be in the enzogenol formulation. But I have some 250mg tabs now and usually take a gram a day.
When I first contracted HCV, and since, I was into megadose ascorbate. I can't guarantee I used it on the day I got infected, but I used more than the average bear for many years.
It did me some good, it did me some harm, with regard to digestion and urinary pH.
I.V. ascorbate is an amazingly good substitute for opioids if you're in withdrawal, much better than any non-opiod pharmaceutical.
I pretty much agree with Cathcart:
"Chronic hepatitis C is more of a problem; however with massive doses of ascorbic acid orally, a no-sugar diet, vitamin E, selenium, silymarin (an antioxidant from milk thistle), and alpha lipoic acid among other nutrients, I have never seen a case to go onto acute hepatic necrosis or cancer of the liver."
This is Burt Berkson's protocol. It does work (especially when Low Dose Naltrexone is added)

I developed my protocol because too many people with HCV can't afford customised supplements; I have always been looking for the budget alternative that can be afforded for as long as the infection lasts. Low-carb and paleo give this edge; if you can then add the supplements, so much the better.

Puddleg said...

The first link above is to the written interview with Dr Berkson, the second to YouTube.

Puddleg said...

@ majkinetor, I think I mentioned how little I supplement at present in order to illustrate that a lifestyle of wise choice of macronutrient ratios, avoiding food toxins, and consuming whole animal foods has a powerful sparing or potentiating effect on supplements.
I used to need the whole LEF Hep C supplement protocol just to feel comfortable some of the time; now I take these very few things, at low doses, and I could probably stay healthy enough without them.

majkinetor said...

Yes, good diet can spare supplements, obviously. But not to the extent where you don't need them. Food industry made it very impossible to do so. If you just glance some papers about animal and plant industry you will see that deficiency is the norm.

LEF is pretty expensive IMO, but you can get powders pretty cheap. For instance, I get 1kg of pure ascorbic acid for around 20E.

When I first contracted HCV, and since, I was into megadose ascorbate. I can't guarantee I used it on the day I got infected, but I used more than the average bear for many years.
Mhm.... define your megadose. I find it very strange that you got the virus while on C megadose ... although following your blog it might be due to lipophilic nature of the virus.

BTW, if those supplements that Cathcart mentions are good, perhaps adding NAC to the mix is a good idea. This paper provides some background and refs:

Puddleg said...

I found NAC very helpful, I also used methionine for the same effect. But last time I took NAC it seemed superfluous.
I would recommend anyone approaching this with symptomatic hep C to supplement a mix of antioxidants, herbs, vitamins (esp. niacinamide, ascorbate, D3, B12), and minerals (especially selenium, zinc and magnesium).

But assuming the virus persists, diet becomes most important. Everything absorbed by your gut will go through your liver; heaps of bioactive material (PUFA, glucose, fructose) or immunogenic (milk, grains) or toxins, that you can limit to improve function and immunity.

Animals (unlike plants) won't grow if deprived of the same nutrients that humans need. Sea fish can get everything they need. Eating animals nose-to-tail is a good insurance against deficiency. Not eating antinutrients and toxins is another. I'm lucky to live in a country where farm animals still eat grass and fish are still caught in the sea.

bugbeegoo said...

everything I'd read about animal meat and liver disease cirrosisis hep c ..said meat was toxic and can increase 'bleach' annomia levels leading to swelling of stomach and yellowing of eyes..we were on the understanding a high vegtable diet was much healthy..please explain..were willing to do whats best for my husband as far as diet but, lots of meat? this is the first we have heard of this..thankyou..

Puddleg said...

We are talking about increasing the use of fat as a fuel instead of carbohydrate - protein intake doesn't need to increase. Animal protein is no different from plant protein in its ammonia content.
Protein is protective of the liver and only people with advanced cirrhosis need to consider their intake. Protein isn't the CAUSE of cirrhosis - if anything the opposite is true.
The dietary causes of cirrhosis (apart from alcohol) are firstly highly polyunsaturated oils (any common oil other than olive oil), secondly high intakes of sugar or other refined carbohydrate. Pork may also promote cirrhosis in some way which is not well understood.
Protective foods are
- beef, beef fat, dairy fats, and related animals such as sheep, goats, deer;
- fish and seafood
- coconut, avocado, olive and their oils
- green leafy vegetables
- berries

Root veges, fruits and poultry should be considered neutral in moderation.
Removal of ammonia depends on healthy gut bacteria, with Bifidus being an important one that can easily be supplemented; a lack of this probiotic in people with liver disease sees a big rise in re-absorption of ammonia from the gut.

If you already eat meat and fish you may not need to eat more of it to follow this protocol, just include more fat (mostly saturated, monounsaturated, and omega 3) in place of carbohydrate, especially sugar and grains.
There are plenty of websites about this way of eating and I have linked to some next to the blog.

Puddleg said...

Oh, eggs and organ meats (other than pig) are protective too, and some nuts, especially brazil nuts.

bugbeegoo said...

hi Gerorge..thankyou so much for your fast reply.very good information..I shall let my husband read your reply. I will look out for your new posts. My husband has two (non-cacer) pea sized growths on his liver and hoping this will not change.He has a 'stiff' liver the doctor said..thankyou warmly..x