Friday, August 04, 2006

Nutritionists and Supplements

Nutritionists and Supplements
Nutritionists, in general, know an awful lot about nutrition, and next to nothing about HCV or its treatment. Very few are medically qualified and capable of understanding the effects of interferon and ribavirin on the body. Let's face it, if a GP with seven years training is not qualified to treat HCV, what chance has a nutritionist of being able to operate safely in the area? Usually, they have no access to your medical records, and can only guess at how damaged your liver is, and the dose reductions this often entails. They frequently mistake haemolytic anaemia from treatment for conventional iron-depletion anaemia. One frequently has too much iron, and the other too little. This has serious implications. For instance, a diet rich in iron can be seriously damaging in many cases as it increases iron overload problems often associated with treatment and can cause permanent liver damage. Despite this I am aware of professional nutritionists prescribing herbal supplements described as 'a rich source of iron' to HCV patients on treatment. This is the sort of elementary mistake that should never happen, but it does with alarming regularity. Sooner or later a nutritionist will be sued by a patient forced to undergo an avoidable liver transplant caused by supplements.

The whole area of supplements is one of doubt and danger. Even simple vitamins carry their own problems. For instance, vitamin C is a diuretic, and will increase dehydration symptoms from treatment, make you feel worse, and the extra fluid that you take to compensate will reduce your interferon levels and degrade your treatment success chances. Few people realise that vitamin C promotes iron absorbtion, and will double the quantity of iron absorbed from any food taken with it, risking iron overload problems. This is just one simple example. There are many more.

As a general observation, all of the more common vitamins have been trialled during treatment, mostly in the US. None has been found to have any significant benefit. I can throw a further 'spanner into the works' as follows. Suppose 'supplement X' degrades treatment success rates by half. How would this fact come to light? The answer is that it would not, unless it happened to be part of a trial. The bulk of supplements have not been properly tested, and the possibility of treatment degradation exists for most. How can you be certain that the supplement that you are proposing to take will not damage your chances of a cure? There have been classic cases of liver transplant patients nearly loosing their new livers (and their lives) as a supplement that were taking blocked their anti-rejection medication.

If despite all this, you feel that you need the services of a nutritionist, get your treatment centre to recommend one. If they refuse, or say you don't need one, then respect their decision. They, after all, are the experts!

Most people have adequate knowledge of what constitutes a healthy diet, and the best advice is to try to stick to it. This is not always practical during treatment with low appetite and change in taste. It is better to eat something rather than nothing when you feel rough, and dietary considerations are sacrificed in favour of getting some fuel into your system in the form of any food that you can manage. If this means a trip to MacDonalds, then so be it!
General appraisal - Supplements and nutritionists are dangerous and usually unnecessary.