Hello Oregondaisy,

Yes, supplements don’t appear on most interaction charts because it’s impossible to know what’s in most of them and what doses people are taking. There is no doubt that some will interact, and some won’t but we don’t know which ones.

On the general topic it’s probably worth reading this:

More evidence that routine multivitamin use should be avoided

While it’s not true that 100% of supplements are 100% useless, it is basically true they represent 90% marketing on top of 10% fact – more hope than evidence if you like.

Most patients, taking most supplements, are either no better off, or actually worse off because of them.

There are exceptions, but most people need no more than clean air to breathe, clean water to drink, personal hygiene, and a good varied diet to eat to live a long and healthy life.

If you’d like to list your supplements and what benefits you expect from them, we can have a discussion about the pros and cons of each.

Hello Oregondaisy,

You’re unusual in your supplements in that many of them (not all) have potential benefits or are clinically relevant to you.

Vitamin deficiency following sleeve gastrectomy is known so continuing your vitamins is both a good idea and won’t impact treatment. A mutli B (not just B12) and vitamin D are best.

Nutritional Deficiency After Sleeve Gastrectomy: A Comprehensive Literature Review

Milk thistle contains silymarin and there is some evidence it may help untreated patients

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4076489/

But, there is also some evidence it does not do anything much

https://nccih.nih.gov/research/results/spotlight/071812

While I suspect it should not interact, the best treatment for HCV related liver disease is to get rid of the HCV so stopping milk thistle during treatment avoids any worry of interaction. The major benefits are flowing from the DAAs. You can continue it after, but after treatment, you’ll find your liver enzymes are normal and you can’t get better than that – the cause is gone so…

In general, as far as your body is concerned, collagen and gelatin are just different forms of protein. They will be digested in your gut into their constituent amino acids and from there do no more, no less than eating a little chicken, red meat or fish. I’d rather have the real food myself, it’s tastier and more natural.

That said, undenatured type II collagen (UC-II) is not intended to be used by your body as a collagen re-builder. In a process called oral tolerance, very small doses of UC-II are taken to train your body’s immune system to stop attacking its own collagen

Here is a vox pop on it:

http://blog.arthritis.org/living-with-arthritis/collagen-supplements-helpful-arthritis/

And here is a medical literature review suggesting a net benefit:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4970562/

So UC-II in low dose would be a probable yes. It should not interact with DAAs.

With Chondroitin/Glucosamine there is some weak evidence they may help. I certainly have patients who say they benefit. Here is a review:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241539/

So I’d suggest that while on the treatment:

1. You should take the B complex + Vitamin D and it won’t interact.
2. I’d skip the Milk Thistle for now and don’t think there is going to be a reason for it after.
3. General collagen and gelatin are no better than fish/meat based food which is natural and tastier.
4. UC-II collagen at low dose may be useful and won’t interact.
5. The chondoitin/glucosamine are fine to continue, probably beneficial and won’t interact.

Very good information Dr James, thanks for that. Best of luck Oregondaisy, looking forward to hearing excellent news from you in a few months.

What medication are you taking?

Ah yes, I remember. You have to take a proton pump inhibitor. You can take the calcium but not at the same time as the medication.

This response helped me as well! Thank you!