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Saturday 23 February 2019

Why the High-Fat Hep C Diet? Rationale and n=1 results.

[pinned post hence the unusual date]

I originally started this blog to publicise the hypothesis that a diet low in carbohydrate and linoleic acid, but high in saturated fat and long-chain PUFA, will inhibit HCV replication.

The blog header with the pig above is the abstract for this hypothesis.

I first worked this out in 2010 after reading Dr Atkins New Diet Revolution while studying HCV replication. The lipid patterns in low-carb dieters - low TG and VLDL, high HDL, normal or high LDL - are those associated with lower viral load and improved response to treatment in HCV cases.
The mechanics of HCV replication and infection support this link.

HCV inhibits PPAR-a, a ketogenic diet reverses this inhibition

I wrote a fairly comprehensive version of the hypothesis in 2012:

Recently I was sent a link to an article that cited this paper: and the hepatic lipid pathway as a potential treatment target. Bassendine MF, Sheridan DA , Felmlee DJ, et al. Journal of Hepatology 2011 vol. 55 j 1428–1440

This review compiles a great deal of supporting evidence regarding the interaction between HCV and lipids, and between lipids and HCV. The only thing missing is the role of carbohydrate. It mentions multiple lipid synthetic pathways as targets for indirect-acting antiviral drugs (IDAA), pathways which are also well documented as targets of low carbohydrate ketogenic diets, or of saturated fat in the diet (in the case of the LDL-receptor complex).

From 2012:
A little n=1 experimental data; 4 years ago (2008) my viral load was 400,000 units, now after 2 years of low carb dieting and intermittent mild ketosis (2012) it is 26,000.

Later in 2012:
Total Cholesterol:  6.7  H     
Triglyceride:          0.8         
HDL:                     1.63              (63.57)
LDL (calc.)            4.7   H    
Chol/HDL ratio:     4.1          

HCV viral load on this day (21st May 2012): 60,690 IU/mL (4.78 log)

Lipid panel from 07 Feb 2012, during ketogenic diet phase (non-fasting)

Total Cholesterol: 8.9   HH  (347.1)
Triglyceride:         1.3          (115.7)
HDL:                    1.65         (64.35)
LDL (calc):           6.7    H    (261.3)
Chol/HDL ratio:     5.4   H

HCV viral load on this day: 25,704 IU/mL (4.41 log)

From 2014:
On a personal note, I have started an 8-week trial of Sofosbuvir and GS-5816 (Vulcan). It is day 11 and it seems tolerable so far.
A pre-trial blood test on 22nd October was normal except for these counts:
AST 74
ALT 174

and viral load was 600,419 (log 5.78), counts consistent with the tests I've had done this last year.

But the day the trial started, 18th November, before my first dose, things were different:
AST 21

ALT 32
Viral load 27,167 (log 4.43)

The low viral load is easy to explain; I get a consistent 1 log drop (to 14,000-60,000*) when I try to eat very low carb (50g/day or lower) and an elevation to 400-600,000 when my carbohydrate intake is over 50g/day. When I ate very high carb (but took antioxidant supps) it was as high as it was on 22nd October. So for me the tipping point seems to be where ketosis begins, and other variations don't have much effect; it's an on/off switch, not a dial (and the name of that switch is PPAR-alpha).
[edit: though the very low scores are at ketogenic, or nearly so, carb intakes, the exact increase in carbohydrate needed to cause a significant increase in viral load seemed to vary]
(I do however, according to CAPSCAN elastography, have zero excess fat in my liver, which is an effect of low carb in general, as well as avoiding vegetable seed oils).

My belief is that my viral load was much higher than any of these counts previous to 2003. This was the year I started taking antioxidant supplements, eating a bit better (in a normal, confused "healthy eating" pattern), and using herbal antivirals like silybin. Prior to that I was seriously ill, and I believe that my viral load would have reflected my extra autoimmune symptoms, signs of liver failure, and elevated enzymes. Unfortunately in those days one didn't get a PCR unless one was considering donating one's body to interferon, which I was not.

* I don't seem to have a record of the date of the 14,000 VL reading, but will include it when I find it.

A very low carbohydrate ketogenic diet, without enough PUFA to lower LDL artificially, had a significant inhibitory effect on HCV viraemia in my case.
Effective DAA drugs for HCV infection are now available. There is a ~98% SVR rate at present. These drugs are expensive, they sometimes have side effects (though much less so than interferon + ribavirin), and interferon + ribavirin is still being used.
If my results are more generally applicable, VLCKD diet offers an adjunct therapy for patients with a high viral load, steatosis that relates to diet and lifestyle as well as HCV infection, or a need to postpone treatment. In people who oppose or cannot complete or afford treatment, it offers a way to manage the disease, and in particular to reverse the autoimmune syndromes caused by immune complexes when viraemia is excessive.


Unknown said...

Thanks so much for your work, George. Although I don't suffer from Hep-C, I'm an avid reader of you blog for your spirited and intelligent inquiry (and your cultural-philosophical musings, too). I'm also always happy to see your astute and civil comments around the blogosphere. You're like a friend around town I'm always happy to run into!

Puddleg said...

Thanks! Really nice of you to say. Makes me feel like deleting the last too-pointed comment I wrote on a blog.

tess said...

yes, Robert said it all! thank you for all the great work!

Anonymous said...

Group hug?

While some people find it fun to mock n=1, I find them fascinating - particularly when the 1 has done so much study and self experimentation.

Given that epidemiology is usually based on lots of people who I have very little in common with, your experiences are quite valuable, George.


Anonymous said...

Hi George! I just came upon this article of yours while doing some online researching of Keto diets. I have chronic Hep-C and am in pretty good health and not overweight (5'4 120 lbs) but I recently had a gallbladder ultrasound that showed a fatty gallbladder and possible fatty liver, the gastro dr did other tests but all those were normal. I do not drink alcohol or smoke but my diet is very high in carbs. I did the interferon combo treatment in 2009/2010 but hep-c came back in six months. My viral load is around a million, and geno type is 1a. Do you think I would benefit from a keto diet? Sorry this post is so long, I'd appreciate your input, thank you!

Puddleg said...

Hi Tammy,

I am pretty sure that reduced carbohydrate intake will help with the fatty liver and lower your viral load. It would be best to use fats like coconut and butter/ghee and increase slowly so the gall bladder adjusts (these the are easiest fats to digest without a gall bladder, so they will exercise the gall bladder enough without asking too much of it - it can hurt if you start using it more all of a sudden).
As to whether you need to be fully ketogenic, this depends on a few things (like whether you can normally eat enough calories). But trying for a ketogenic diet without worrying too much about whether or not you're producing ketones is a good way to start. Then you can see how you feel. You may decide you prefer to keep a little carb from root veges and fruit in the diet - I usually do, but not before midday, this gives a long window without carbs each day.
Depending how you feel, but at your weight I'd avoid reducing your appetite and calorie intake. Especially if you are into exercise.

Unknown said...

Thank you very much for this information George, I suffer from Hep C genotype 5 since 2007, after a series of eleven months on Copegus and Pegasys, which made me so sick, I decide to try heal myself. I did some blood ozone which was extremely painful at times as the doctor had huge problems finding my veins which was not very cooperative after two weekly blood workings during eleven month treatment. Then I was introduced to LCHF lifestyle and never look back. My gastroenterologist think that i'm living in a dream world and that my liver cirrhosis will not improve I should follow some new course of medication that they found. He is a good friend as he treat me for years and help me try anything we can think of but he is not very keen on this lifestyle... I will be printing this for him maybe it will let him realize that i'm fine because even after the pathologist cannot get any viral load as their equipment register none he is not really believing that this could have worked. My viral load use to be in the 8 millions and the pathologist assure me they did the test three times when they realize that is do not register they even use another machine. Thanks you very much for explaining it.

Puddleg said...

Wow! Thanks very much for posting that.

Gerald said...

Hello George,

Not sure if this is the correct place to post but I'll give it a go.

I have Gallbladder Polyps (cholesterolosis) and mild fatty liver, and would like to get some ideas on how to get rid of both these problems.

I have leaky gut and cant eat Gluten/Dairy and sometimes soy, I dont know how I got these polyps, but I did have Gilberts syndrome for many years but the doc said its ok, I assume my phase II detox in the liver is sluggish.

I have been taking SSRI and PPI medication (Paxil and Prilosec) for depression/anxiety and GERD/Hiatal Hernia for 20yrs, recently trying to reduce but found it very hard to.

Im overweight and have been for those 20yrs, Im about 105kg and should be 75kg, Im stuck on what kind of diet can help me heal from these polyps, my idea was to get my body to go into autphagy and so I started fasting 18hrs and would feed for 6 hrs, autophagy I figured may help shrink or munch those polyps.

I drink lots of water during the day (fasting period) so my bile doesnt thicken, and drink tumeric tea, milk thitle, ginger, mint, chamomile teas to help keep bile flowing and avoid bile stasis or saturation of bile/cholesterol in the gallbladder.

I was wondering what your thoughts are in my case, thankyou for any ideas you can come up with.


Puddleg said...

Hi Gerald,

I only know some facts about cholesterol metabolism
1) synthesis is activated by insulin, decreased by glucagon - so fasting, keto, paleo are logical ways to go. Also, cholesterolosis also involves triglycerides, making insulin reduction even more logical
2) cholesterol can crystalise if it can't a) form esters or b) form bile acids and salts
- try to divert it into these excretable forms - this requires AA, EPA, DHA (Krill oil is probably a good supplement here), taurine (I think definitely worth supplementing), glycine (bone broth, oxtail, tendons etc), Magnesium (there might even be a magnesium glycinate supplement)
3) fat in the diet keeps bile flowing, there's a high risk of gall stones while losing weight on low fat diets
4) fibre can pull cholesterol from bile out of the body

I hope some of this helps!

LA_Bob said...

George, what is with the dates on the post and some of the comments? The post is dated Saturday, 23 February 2019, and some of the comments are from early 2015. Is this a case of people commenting two years ago on a post you plan to publish two years from now?

What prescient readers you have!

Honora said...

Thanks for the update on the High-Fat Hep C diet. I recommend this blog to people with Hep C so it's good to have this summary of your n=1 experiences.

I do warn them that your posts contain science!

Puddleg said...

Hi Bob,

I had published this post in 2015, but I decided to pin it to the top by changing the date so that people who visited due to Hep C didn't have to wade through unrelated posts. Dates on comments are correct.

Hi Honora, Thanks!

kate said...

As a sign of gratitude for how my husband was saved from hepatitis b, i decided to reach out to those still suffering from this.
My husband was diagnosed of hepatitis b in 2013 and it was really tough and heartbreaking for me because he was my all and the symptoms were terrible, he always have Joint pain , and he always complain of Weakness of the body . we tried various therapies prescribed by our neurologist but none could cure him. I searched for a cure and i saw a testimony by someone who was cured and so many other with similar body problem, and he left the contact of the doctor who had the cure to hepatitis b. I never imagined hepatitis b has a natural cure not until i contacted him and he assured me my husband will be fine. I got the herbal medication he recommended and my husband used it and in one months he was fully okay even up till this moment he is so full of life. hepatitis b has a cure and it is a herbal cure contact the doctor for more info on on how to get the medication. Thanks for reading my testimony.

Unknown said...

Hi George. I was, like others, wondering your thoughts for my situation. Ive had hep c for about 16 year. I’m in pretty good overall health. I workout a few times a week and my trainer kept boasting about how great a ketogenic diet is for ones overall health. I tried it and I love the added energy, reduced appetite, loss for the need to snack and the overall sense of well being I feel. I wasn’t necessarily trying to lose weight, I just want to stop snacking. I didn’t realize how much better I’d feel overall. I am way more focused at work and that’s great. Even 14 years after completing interferon/ riboviron treatment, I still have some side effects with focus and concentration, so this really matters to me. I have also noticed an ache in my lower right abdomen which is what started my concern. It’s a dull ache. And that seems it may a normal side effect from ketosis. I found contradiction information on Keto diets and hep c. So I was just wondering the opinion of someone to whom has actual experience.

Sue D

Puddleg said...

Hi Sue,

lower right abdomen is where the appendix is; however appendicitis really hurts and is also nauseating, you'd certainly know if you had it, and usually an appendix is most stressed by high carb-and-fat food like cakes (which is how I lost mine), and isn't seen in peoples eating traditional diets without sugar and starch.
But it could relate to changes in gut bacteria in that region.
"The diagnosis of a "grumbling appendix" as a cause of recurrent pain in the right lower abdomen is much less certain."
See if reducing fibre helps; it's easy to overeat types of fibre you're not used to on a low carb diet. It's also possible to pull muscles doing exercise there if you're not used to it.
Hope this helps, it sounds like you're doing great.

Unknown said...

Thanks for the quick feedback . It’s a dull ache and it comes and goes. It started about 4-5 days into the Keto diet. My stomach has also been grumbly, so maybe it is a change in bacteria. I just want to make sure I’m not causing bigger issues.

Unknown said...

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Betsy said...

George, do you know if keto is good for other viruses such as shingles or herpes simplex?

Puddleg said...

Hi Betsy, not specifically via any replication pathway as with HCV, but generally via autophagy and antioxidant status it should help. Also consider selenium and vitamin D3 status for shingles specifically. for HHV the South African herb Koloba has some research.

Betsy said...

Thanks, George. What a coincidence. Just yesterday I decided to try selenium for the sick headache that I very frequently wake up with. I have a liquid sodium selenite, I took a 1/2 dose every 1/2 hour, can't remember how many doses, and I felt much better. So I looked up selenium plus viruses and saw that it's helpful for coxsackie virus and chronic fatigue. I've had chronic fatigue for a long time.

I have recently been trying to take D3, too, but it seems my morning headache gets much worse when I take it. I will continue with the selenium for a while and then add in some D again.

I'll look up the Koloba.

Thank you, I appreciate your site.

Donald McManus said...

"It is a great post for weight loss. Loss weight is the important issue for this time.isotonic exercise examplesthis food or exerciser can help your weight loss"

Betsy said...

George, did you know that some viruses produce IGF-1?
It doesn't look as if Hep-C does, but I thought you might find it interesting.

"Scientists have identified four viruses that can produce insulin-like hormones that are active on human cells. The discovery brings new possibilities for revealing biological mechanisms that may cause diabetes or cancer."

Unknown said...

Viral load in September: 633,072
Viral load in December: 200,983
ALT: before 165
AST: before 233
ALT: after 97
AST: after 152
Started keto October 13th so after 2 months my VL dropped about 33% following a ketogenic diet allowing 50g of carbs or less with a total of about 5-10% of calories from carbs. My blood ketone levels were between 0.7 mmol and 2.5 mmol of BHB throughout the day. I will try lowering overall carb intake to no more than 30-40g a day or possibly less to see the effects on VL and liver enzymes in a few months.

adamkern8 said...

Hi George,

Would a teenager need to eat more carbs than ketogenic to grow properly and be in optimal health? Also, what would you say about even the Inuit eating muscle glycogen and not being in ketosis?
Thanks so much

Puddleg said...

1) maybe, but protein will substitute for carbs to some extent and if there is a medical reason to be in ketosis this will probably help rather than hinder growth.
Try modified Atkins if this is a concern.
2) nothing to do with muscle glycogen - there is not much, it degrades easily after a kill, and wouldn't they go back into ketosis between meals even if there was enough to stop it temporarily? If glycogen is present and available in muscle, we're not talking about rice and potatoes, more like just a small piece of fruit with a meal. Anyway, zero carb carnivores test this hypothesis every day and I think they're in ketosis. Some, but not all, inuit have a fatty acid transporter mutation that inhibits ketosis - but this idea was based on a limited case study and is contested now that others with the mutation have been found to go into ketosis normally.

adamkern8 said...

Thank you so much for your reply.
One final question: what is your opinion on milk? I end up drinking a lot because it’s difficult to get enough fat in, but I’m not sure it’s ideal

Puddleg said...

If you're not intolerant of some component of milk like lactose or casein I don't see any evidence that it's harmful; at least, full-fat milk has no harmful signal in epidemiology; and lactose seems to be the least problematic common sugar metabolically in diabetes.

adamkern8 said...

Do you have any suggestions for depression, acne, and eczema? Have you heard and have any opinions on Grant Genereux’s vitamin A toxicity argument?

Puddleg said...

Have you tried the all-meat diet? Good for mood disorders (any keto diet is) and acne (ditto) - and eczema might clear up without milk.

adamkern8 said...

Haven’t tried all meat because it would be impossible to get enough calories, but perhaps eggs, butter, dark chocolate and almonds, with some meat would do the same?

Puddleg said...

Maybe, it's worth trying - sounds good, OK to use olive or coconut oil too.

adamkern8 said...

Have you heard of the vitamin A deficiency theory by Grant Genereux?
also, do you still recommend supplemental fish oil and vitamin D?


Puddleg said...

Genereux seems to think vit A in all forms is toxic.
I'm not even going to bother with that idea if not taking retinoid pills or supplements or supplemented foods.
Discussion in comments here

I don't supplement fish oil because it's so easy to eat some fish, lamb, and limit vege seed oils, but maybe worth it for someone starting diet change with high 6:3 ratio.
Vit D is definitely worth supplementing in winter, or until you can safely tolerate high enough sun exposure.

adamkern8 said...

I read Masrterjohn's comments.

You have to keep in mind, Masterjohn has recommended large dose Vitamin A for years, and is closely affiliated with WAPF, which started the whole Cod Liver Oil trend, so he isn't exactly unbiased. His source of income is literally tied to it.

Secondly, his dismissal sounds exactly how conventional science has reacted to every new discovery. Like how vegans dismissed Low carb and the benefits of saturated fat. He calls it bullshit quackery and then says he doesn't have time to read it. It isn't just some random guru's theory. There are 3 free ebooks with more than just anecdotes. Genereux analyses many studies and makes a cohesive argument.

Nobody needs to think he is right in the end, but the dismissive attitude is exactly why low carb took so long to gain traction. Dogma and money.

Puddleg said...

You have people using retinoid drugs, you have retinol supplemented foods, you have the recommendation of diets supplying more carotene than anyone ever ate in paleolithic times, (show me hunter-gatherers eating green salads or cooking non-starchy veges regularly) and vitamin A pathways are incredibly complex and dependent on immune function, which is disrupted today by other factors.
So for these reasons a vit A hypothesis for some cases is plausible - under those conditions. But not a general claim that it's toxic. Vitamin B6 is toxic because excess inhibits its own essential functions. This might be roughly analogous to the vit A problem, where the symptoms described are not the classic overdose ones.

adamkern8 said...

Hi George,

Would you mind clarifying your stance on dietary iron from meat? Is it important to chelate it using various herbs or supplements whenever you eat it if your diet is highly centered on meat? Or is this a misinterpretation?


Betsy said...

Hi George, a friend just emailed me saying he just found out he has Hep C, and along with that he has high iron. They are going to be doing blood letting on him, every two weeks.

Do you have any thoughts about the high iron?

I gave him a link to your blog.

Thank you

Puddleg said...

Hi Betsy, blood letting for Hep C has lots of evidence in its favour. But if you treat the Hep C and liver inflammation, the iron can come down - the hepatitis is usually interfering in its regulation.

Betsy said...

Thank you, Puddleg, I have passed your information on to my friend. He just informed me today that his daughter is going to take him to a nutritionist who has something for lowering iron, and he will go along with the blood letting if necessary. He is still in a state of shock. He was taking Imuran for fibrosis in the lungs, and I think he said the doctor thinks that had a lot to do with raising his liver enzymes so high so quickly. He's caught in the vicious circle now, the doctor is taking him off Imuran and putting him on Cellcept, just another immune system suppressor.

Thanks again for taking the time to answer my question.

Puddleg said...

Hi Betsy, if I was your friend I'd treat the Hep C with a direct-acting antiviral drug (NOT interferon or ribavirin). These are very safe and effective. Then, he won't need to worry about that aspect of his problem, and the iron should improve.

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