TOPIC:

So as you probably know I'm keeping an eye on everyone's progress and for the vast majority (as in 96.2% to be exact) we see HCV RNA <LLOQ (ie <12, <15, <25 or <30 depending on the test) by 4 weeks.

As we know daclatasvir levels go up if you take inhibitors of CYP3A4 and down if you take inducers. To date we have only see issues with inhibitors like grapefruit, grapes, paw paw, star fruit and pomegranate causing toxic daclatasvir levels. Bad for patient, ok for SVR.

Today I got a shock. A patient with F0-1 GT3a and an initial viral load of 3,100,000 came back with a 4 week viral load of 935.

This was previously unheard of. So we started looking why.

First the source of the medications (FixHepC) so I know they passed testing, but I can also see the results for the patients immediately before and after which are all as expected - <15 or UND everywhere. Rule out dodgy batch of drugs as the cause.

Next her medications. All green light on the interactions checker: www.hep-druginteractions.org/checker

Now her supplement - a body building energy potion taken daily and containing:

• Taurine
• Caffeine
• Green tea extract
• Green coffee extract
• And the list went on...

So I Google for taurine and find and article called Taurine modulates induction of cytochrome P450 3A4 mRNA by rifampicin in the HepG2 cell line.

In plain english this says taurine increases the levels of the enzyme CYP3A4 that removes daclatasvir from your system - in other words it's like you're taking a 1/2 dose, or maybe even a 1/4 dose.

Now taurine may not be the only cause each and every "... extract" will contain dozens of chemicals, all of which could induce or inhibit CYP3A4

So here is my advice:

Do not take random supplements in the hope they may help. They may, they may not - nobody knows and these drugs work without special care. If you want to take extras Vit D and Vit B12 have evidence and there is a long discussion on the forums about many others.

And remember that Red Bull, V, Monster and other "Energy" drinks all contain taurine

Here's more about taurine if you're interested

www.mayoclinic.org/healthy-lifestyle/nut...taurine/faq-20058177

Very interesting. It's great to see information of possible interactions, both positive and negative, come to light. We've all been sailing in mostly dark, uncharted waters without navigation lights and this is invaluable for future patients.
Personally I have continued to take Jeunesse AM/PM Essentials which I started several months before treatment and made a noticeable improvement to my feeling of well being, although I take less than 1/2 the recommended dose (it's quite expensive). It contains small amounts of taurine and green tea extract among dozens of other things. I was DET <15 at 4 weeks.

Green tea extract is very bad for the liver. A Perth man was recently at death's door from it and he needed a new liver. They had to give him one that was infected with HBV.

I suppose in very small amounts it might be OK but I wouldn't try it.

Johnboy wrote: Green tea extract is very bad for the liver. A Perth man was recently at death's door from it and he needed a new liver. They had to give him one that was infected with HBV.

This is the story you mentioned -
www.abc.net.au/news/2016-02-14/man-faced...loss-product/7162378

Green tea extract was mentioned as the probable cause although doctors were uncertain. I would guess it was present in large quantities in the "weight-loss product purchased online".

With a little more searching I found vastly conflicting reports, from a girl who got very sick from 3 cups of green tea a day:
www.techtimes.com/articles/88334/2015092...-of-liver-damage.htm

to a report that it helps fatty liver:
www.liversupport.com/green-tea-promotes-a-lean-liver/

Extracts are never reliable really. Herbs I'm happy taking in large amounts when fresh or dried become toxic to me when in extract form. I've tried several times and its always the same. I take extracts , even from trusted sources and I get liverish headaches and infernal itching.
Its so predictable now I stay well clear of them. I wonder if it will be the same after treatment. I do think you can mistakenly overstimulate your immune system when you have hep and suffer for it.

I do think you can mistakenly overstimulate your immune system when you have hep and suffer for it.

Liver fibrosis is not directly caused by the hepC virus. It is caused by inflammation set up by the immune system in response to the virus. So paradoxically, your Viral Load number bears no direct relationship to the progression of your liver damage, and trying to ramp up your immune response could be counter-productive.

A much better approach to protecting your liver (while not on tx) is the use of natural anti-inflammatories, for example like cooking with turmeric.

dt

Yes DT thats what I found out the hard way.
In the end it was the Turmeric that won the day.
But I also realised that whole herbs are whole for a reason, and that extracts are almost always inferior.
Human beings always meddle with things too much.
Whatever I've done to myself it hasn't been too detrimental to my liver. I had a fibroscan yesterday...4.7kpA.
Not too bad after probably thirty years with this virus and an extremely misspent youth.

flyingfox66 wrote: Yes DT thats what I found out the hard way.
In the end it was the Turmeric that won the day.
But I also realised that whole herbs are whole for a reason, and that extracts are almost always inferior.
Human beings always meddle with things too much.
Whatever I've done to myself it hasn't been too detrimental to my liver. I had a fibroscan yesterday...4.7kpA.
Not too bad after probably thirty years with this virus and an extremely misspent youth.

Research shows the complete opposite. Especially when it comes to Tumeric. The good parts (curumin) is not absorpable and they need to make a extract to get some absorption. Extracts are mostly always better for absorption and to get the most precise part of the plant or herb.

Curcurmin extracts have been linked to liver failure too.
If the curcurmin in turmeric wasn't bioavailable in the mixture I make, it would have all the amazing symptom relief that it does.
Perhaps people just don't know how to prepare it.
Plants are synergistic medicine...a recipe of parts, not a single part that can be drilled down and "isolated".
Its such a masculinist fallacy
I'll leave it at that though cos this is seriously off topic.

flyingfox66 wrote: Curcurmin extracts have been linked to liver failure too.
If the curcurmin in turmeric wasn't bioavailable in the mixture I make, it would have all the amazing symptom relief that it does.
Perhaps people just don't know how to prepare it.
Plants are synergistic medicine...a recipe of parts, not a single part that can be drilled down and "isolated".
Its such a masculinist fallacy
I'll leave it at that though cos this is seriously off topic.

Masculinist fallacy? I guess we will just disagree then. Some know better then others and will always have different opinions. For the massess out there don't believe everything you read and do RESEARCH. Real research and not sites like Doctor Mercola or Mike Adams (Health Ranger)etc.

Masculinist fallacy?

No, that would be Patronizing Masculinist Fallacy.
dt

dointime wrote:

Masculinist fallacy?

Patronizing Masculinist Fallacy.
dt

....cute!

I don;t know why taurine treatment was failure.
Taurine Function:maintain the brain function and accelerate the development of baby and children’s brain, accelerate the growth of the nervous system, accelerate the digestion of fat and plays a role in gall bile metabolization, protect the body’s cardiovascular system.

Hi Han,

Please see Dr Freeman's explanation in the first post of this thread. In summary, taurine is an essential compound as you say but it is also an inducer of the CYP3a4 enzyme which is what metabolises Daclatasvir. That means that increased levels of taurine increase the rate at which Daclatasvir is removed from our bodies therefore reducing its effectiveness. So while we need taurine to survive and it is a natural part of our diets, we should not add extra via supplements or energy drinks during treatments that contain Daclatasvir. An example where 'more' doesn't necessarily equal 'better'.

Bristol-Myers Squibb who make and license Daclatasvir have recognised this is a potential issue per below quote and link.

In addition to herbal and dietary supplements which may increase DCV exposure via CYP3A4 inhibition, others may induce or modulate the induction of CYP3A4 and thus potentially reduce the antiviral activity of DCV. Such extracts include St. John’s wort (Hypericum perforatum; a strong inducer of CYP3A4 and thus contraindicated for concomitant use with DCV) [36] and taurine (commonly found in body-building supplements and energy drinks) [38].

link.springer.com/article/10.1007%2Fs12325-016-0407-5