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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:
http://hopefulgeranium.blogspot.co.nz/2012/02/do-high-carbohydrate-diets-and-pufa.html

Recently I was sent a link to an article that cited this paper:
http://www.journal-of-hepatology.eu/article/S0168-8278(11)00492-2/pdfHCV 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.

Summary:
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.


13 comments:

Robert Brain 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!

George Henderson 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!

Spittin'chips 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.

Ta.

Tammy Williams 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!

George Henderson 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.

Expatfamily Joubert 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.

George Henderson said...

Wow! Thanks very much for posting that.

Calogero Fiore 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.

Gerald

George Henderson 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!

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 Renwick 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!

George Henderson 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!