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“Dr. Melissa Palmer's Guide to Hepatitis and Liver Disease: What You Need to Know”

In this book, liver specialist Melissa Palmer, MD helps people who have been diagnosed with Hepatitis C and other liver diseases understand their diagnosis, evaluate their treatment options, and make healthy changes to their diet and lifestyle.


Healthy Hepper.com's Interview with Dr. Melissa Palmer on Hepatitis C Treatment

Conducted August 30, 2009

1. Please tell us about yourself and why you wrote your book, “Dr. Melissa Palmer's Guide to Hepatitis and Liver Disease: What You Need to Know”.

My name is Dr. Melissa Palmer, and I've been a Hepatologist - liver specialist, since 1988. I was drawn to this field in the early 1980's, when we were not so fortunate to have so many medications available to treat and potential cure diseases of the liver. My so-called claim to fame was that I was among the first physicians to notice that weight reduction, healthy diet and exercise may actually reverse damage done to the liver by fat. This is a concept that needs to be underscored especially in today's world where obesity is affecting an extraordinarily high percentage of Americans. Being overweight, and having fat in the liver - known as steatosis, has repeatedly been shown to worsen the course of people with hepatitis and accelerate progression to cirrhosis. Thus, it is exceedingly important for all people with hepatitis to maintain a normal weight, exercise and adhere to a healthy diet.

I maintain a practice devoted to treating patients with liver diseases in Plainview, NY, and I frequently see people from all over the U.S. and other parts of the world. I am also Clinical Professor of Medicine at NYU and Medical Director of Hepatology at NYU Hepatology Associates/Plainview.

My mission in writing " Dr. Melissa Palmer's Guide to Hepatitis and Liver Disease was to break through the wall of helplessness that at times surrounds liver disease and to provide people with the genuine hope that they can get better.

2. Any recommendations for those who are newly diagnosed with HCV?

Yes. It is crucial to find a doctor specializing in the treatment of liver disease - (Hepatologist). These physicians are aware of the newest advances in the field, and may even be able to offer patients new treatments before they are readily available in the marketplace. There are other types of physicians who can treat liver problems, such as Gastroenterologists, but often their practices concentrate on diseases of the digestive tract such as ulcers and colon cancer, not on hepatitis.

3. Do you believe in eliminating the Hepatitis C virus? Is it possible to do this with natural medicines?

Yes, the Hepatitis C virus can be CURED. However, while natural remedies may enhance the immune system, and may act as antioxidants, assisting in keeping us protected from environmental toxins, it can not cure hepatitis C. Only interferon in combination with ribavirin has been demonstrated to actually cure this disease in over half of patients infected.

4. If the Hepatits C Virus cannot be eliminated, but viral load remains low and liver enzyme levels remain normal, is it still causing harm?

Yes. The viral load and liver enzyme elevations typically does not correlate with the degree of damage being done to the liver. Although, there has been some recent evidence that people who have a persistently high viral load ( > 1 million IU/dL) have a higher likelihood of leading to cirrhosis and its complications. However, in general, people with normal liver enzymes and low viral loads have the same chance of having liver damage as those with high values. Actually, if the viral load is low, the chance of cure with standard therapies is very high.

5. Do you think someone with Hep C should take just conventional Medicine or should they also use natural supplements in addition?

As stated above, natural supplements cannot cure HCV, but can possibly protect against environmental toxins. In my practice, anyone who has evidence of a fatty liver, is recommended to begin the following vitamin regimen - Vitamin E 800 mg, Betaine HCL 300-600 mg and Coenzyme Q10 100 mg,l although this regimen is not standard of care. In some studies done on patient’s with chronic hepatitis C, response rates were improved by the addition of vitamin E and zinc to interferon and ribavirin. Selenium deficiency has been associated with fatigue, heart disease, liver disease and sterility. Low selenium levels have been found in some people with hepatitis B and C and it has been postulated that this deficiency may speed progression to cirrhosis and liver cancer. Sources of selenium include brazil nuts, brewer’s yeast, broccoli, brown rice, and chicken. If selenium supplements are needed the recommended dose is 100 mcg (micrograms) per day.

There has been some recent anecdotal evidence that eating blueberry leaves and grapefruits may decrease HCV replication. But, people should be careful in that grapefruit may interfere with the proper absorption of some medications.

6. What can conventional medicine do for someone with cirrhosis? Once someone is diagnosed with cirrhosis, is it too late to turn to alternative therapy.

Since everything we eat, breathe, and take into our bodies must go through the liver to be processed, if extensive liver damage has already been done, taking alternative therapies may put undo additional stress on the liver and is typically not advised. Remember, in the US, alternative therapies and not regulated, and too often - ingredients that are not listed, and potentially liver toxic may be in the remedy you may want to take to help your liver. So, you may actually be harming your liver - be very careful.

As a researcher in the field, myself and many other physicians are currently running trials of new medications aimed at reversing cirrhosis. These medications such as caspase inhibitors, may particularly be helpful in the group of patients who unfortunately did not respond to conventional treatment and who have already progressed to cirrhosis. That is why it is important for people to be under the care of a hepatologist, so that they may avail themselves to these newest therapies if they desire.

7. What do you consider a cure for HCV?

Anyone who has a HCVRNA viral load < 5 IU/mL 6 months after treatment with interferon and ribavirin is done. However, it is crucial to understand that even if the virus is cured, people with cirrhosis may still be at risk for liver cancer and other complications of cirrhosis - so close follow-up with your doctor, and continuation of screening tests for liver cancer is crucial.

8. What do you think about the negative side effects of interferon/ribivirin? What are your beliefs about the effects of this treatment on your health?

Treatment with interferon and ribavirin may be very difficult for both patients and their loved ones. But, unfortunately, all drugs have potential side effects. To realize this, you need only to read the informational insert that accompanies any medicine—whether prescribed or over-the-counter. For any given medication, there is a list of many potential side effects that may occur as a consequence of taking the drug. This is true even for the most commonly used over-the-counter medications, such as an aspirin or an antacid.

There are some important points to keep in mind when evaluating the risks versus benefits of taking a medication, such as interferon and ribavirin . Side effects vary from person to person. This means that not everyone will experience a particular potential side effect. While some people feel quite ill while undergoing therapy, others experience few, if any, side effects. And there are some people who actually feel better while on interferon. And those who do experience adverse side effects usually do not experience them all the time. In fact, studies have shown that only approximately 2 to 5 percent of people find the side effects of treatment so debilitating that the discontinuation of therapy is necessary.

Side effects are usually the worst during the first few weeks of therapy. So it is important to try to stick with therapy for at least the first 3 months. Actually, studies have shown that if your HCVRNA level is not nondetectable by this point, it may not be worthwhile continuing therapy. Some people schedule time off from work for when they plan to start therapy. Others plan to begin therapy when their work schedule or personal responsibilities are light, thereby making it is easier to get through the initial period. Side effects associated with interferon are usually dose related, meaning that the higher the dose of interferon, the greater the side effects. Sometimes a reduction in dosage may satisfactorily mitigate the side effects. However, studies have shown that adherence to the recommended dose and duration of therapy is directly correlated with success of treatment - i.e. eradication of the virus and regression of liver scarring. Most side effects can be successfully managed by a knowledgeable doctor in conjunction with a motivated patient. Thus, it is advisable to not to decrease the dosage of medication or interrupt therapy unless the risks of continuation of therapy outway the benefits of curing the disease. In other words – if the treatment of the disease is worse and more dangerous than the disease itself. If a serious adverse reaction occurs due to interferon and does not respond to side effect management or dose reduction then discontinuation of treatment is necessary.

It has been demonstrated that people with advanced liver disease and cirrhosis are the ones most likely to experience side effects. The importance of treatment in the early stages of the disease, when people are strongest and healthiest and best able to tolerate interferon, cannot be overstated.

I recently published a study substituting the drug RIBAPAK for ribavirin. This study found that overall, patients preferred Ribapak over ribavirin. RibaPak was associated with improved patient compliance, less side effects, improved quality of life and a trend toward improved perceentage of cure. All patients contemplating therapy should ask their treating physician to consider this medication.

9. What is the one thing you want to share with people who suffer from Hep C that you think might help them over come some of the difficulties they face?

Hang in there! New therapies ( protease and polymerase inhibitors) should be approved by the first quarter of 2011- that have an improved chance of cure even in those with genotype 1- the hardest strain to cure.

About Dr. Melissa Palmer:

Dr. Palmer is an internationally renowned hepatologist who has been practicing medicine since 1985. She maintains the largest private medical practice devoted to liver disease in the United States. Dr. Palmer was trained in hepatology (as well as medical school) at the Mount Sinai School of Medicine in New York City. She lectures frequently on liver disease-related topics to her medical peers and to the general public. She has appeared on television many times and is often quoted in magazines and newspapers. Dr. Palmer is a board member of the New York chapter of the American Liver Foundation, and she sits on the nutrition subcommittee of the national chapter of the American Liver Foundation, the advisory board of the Latino Organization for Liver Awareness (LOLA) and the Primary Biliary Cirrhosis Organization (PBCers).

Her practice is located on Long Island, New York-- at 1097 Old Country Road, Suite 104, Plainview, N.Y. 11803.