Hello ekimyennep,

Wow, that’s possibly the biggest list of supplements I’ve seen a single person taking.

The bottom line is simple enough:

1) We know that food does have an impact on the absorption of medications like Epclusa

https://www.ema.europa.eu/en/documents/assessment-report/epclusa-epar-public-assessment-report_en.pdf (page 55)

With Epclusa, the problem to hand is that it is not very well absorbed and a high fat meal improves that so while the official line is that it can be taken with or without food, I suggest with a meal with some fat in it.

2) While many patients with Hep C do take liver supplements (nd were likely included in the trials) formal testing of drug interactions with almost all the supplements you list has NOT been done.

3) While most people think of a tablet of (say) vitamin C as being a vitamin C supplement it also typically contains half a dozen other ingredients that turn the API (vitamin C) into the tablet.

My suggestion would be to leave the supplements alone for the duration of your treatment. In order of “known not to be a problem”

• DHEA is part of the steroid axis, and although it is not specifically listed at the Liverpool interactions checker https://www.hep-druginteractions.org/checker we can see things like female HRT (oestrogens and progestogens) and cortisols do not interact. In addition, you would probably start to miss this after 3 months
• Milk thistle contains silymarin and is helpful in liver disease. If the liver disease is cause by Hep C then any of the new DAA Rx are MORE helpful but plenty of my patients took it during their Rx with no problem. Note that after patients liver function numbers come back to normal on treatment the logic for it evaporates
• Whey protein
• Vitamin C
• VMultivitamin

Now let’s look at some of the things that you might like to consider, both short and long term.

Vitamin D

Vitamin D is a fat-soluble vitamin, produced in the skin, from exposure to sunlight. Less sunlight in the northern/southern extremes and the need for vitamin D is one of the reasons humans evolved to become paler skinned. Fat-soluble == this vitamin accumulates. This can be a problem https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/expert-answers/vitamin-d-toxicity/faq-20058108

With Vitamin D there is a simple blood test. If you are not deficient you don’t need it. If you are deficient you may like to consider sunshine for its side effects…

Colostrum

I encourage new mothers to breastfeed. That gives their newborn children what nature intended, but that said…

Nature did not really intend for humans to consume cow’s milk – it was designed for baby cows. Are cow antibodies likely to be useful for you? Cow growth factors? …

Colostrum is a liquid and contains live cells as well as other proteins that will not survive spray drying so (and this is probably a good thing) people consuming colostrum are not getting the fresh product, they are getting the “processed food variety”.

I’m none of paleo, vegan or vegetarian so quite happy to eat my yoghurt and cheese. That’s a taste/protein thing rather than a health thing.

In general

In general, a diet that has variety will almost invariably everything needed for good health – supplements are marketed but are not required.

The story of Fish Oil

Fish oil is not a health food. It’s probably toxic, but here is how it enters the zeitgiest.

In the decades after WWII it is noticed that Japanese living in Japan have less heart attacks and strokes then genetically related Japanese living in the USA.

Why? Theory – it is the diet. Ah ha, what is different. Ah ha, fish vs McDonald’s. Ah ha, what is in fish? Ah ha oil!

If you’ve ever been to Japan, and stayed in a hotel, and visited the breakfast buffet, you might have noticed that ~ 90% of all the food on the Japanese side is more or less unrecognisable to Western eyes ie the Japanese diet differs in almost ALL respects to a Western diet.

Anyway, it turns out that after you have filleted a fish what is left are the bones. What do you do with them? Well, we used to make blood and bone fertilizer but that is a low value add…

Ah-ha! Eureeka!Tada!

If you crush waste fish and bone you can remove the oil and put it in a gelatin capsule so thick the consumer will not be able to taste or smell the rancid fish oil flavour and market it…

So starts a 20+ year human experiment. You can look up the results yourself but it turns out stale fish oil does not deliver the same health benefits as a Japanese, living in Japan, eating a Japanese diet.

Hi Michael,

Taking the supplements in the morning and the Epclusa with your evening meal sounds like a good plan.

There is no need to avoid exercise or make any other changes to your routine.

Best of luck with it all and please keep us posted! The odds are definitely on your side…

Kind Regards

James

I’ll jump in here, just in case you are hesitating to start treatment. (Like I was…interferon leaves scars, lol )

Listen to Dr. Freeman, he is one of the leading experts on Hep C treatment. He cured me, and so many other people.