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Medizinisehe Klinik
10<)<l:94:Supp1111:84-9,© Urban & Vogel, Miinchcn

A Conservative Triple Antioxidant Approach to the Treatment of Hepatitis C Combination of Alpha Lipoic Acid (Thioctic Acid),
Silymarin, and Selenium: Three Case Histories
Burton M. Berkson 1 ccording to a recent article, the number o f adults seeking liver transplants for hepatitis C infection will skyrocket in the next 20 years [11]. About 10,()()0 Americans die fiom this disease each year. Deaths are estimated to increase because oCtbe increasing risk o f infection, and the resulting cirrhosis, portal hypertension, thrombocytopenia, bleeding from varices, and liver cancer. Five years ago, 20% o f these hepatitis C patients were candidates for liver transplantation and today the number has increased to about 5()%. An estimated 4 million Americans are infected with hepatitis C and many of them are being evaluated for liver transplant surge W. This expensive process costs roughly S 30 ) ()()(~ during the first 3 months, and can bc painful and incapacitating. Add to this the thousands or dollars for anti-rqection drugs and the costs o~" more fi'cquent visits to health care fiwilities. O f course some people do require liver transplant surgery, h o w ever, the author believes that in many cases, an effective alternative therapy exists. Often, patients with progressive hepatitis C, who seek a more conservative treatment, prior to SUl;gery present to our facility. These patients arc treated with a program that includes and c o n > bines alpha-lipoic acid, silymarin and selenium. Most patients recover quickly, however, a few find it difficult to follow a healthy nutritional and lifestyle program, or their condition is so ~ar advanced that they go on to liver transplant surgery. In this paper, the case histories of 3 patients are presented.

ABSTR,ACT transplantation for hepatitis C in the last few years and the count is going up rapidly. There is no reliable and effective therapy for chronic hepatitis C since interferon and antivirals work no more than 30% of the time, and liver transplant surgery is uncertain and tentative over the long run. This is because, ultimately, residual hepatitis C viremia infects the new liver. Furthermore, liver transplantation can be painful, disabling and extremely costly. Treatmem Program:The author describes a low cost and efficacious treatment program in 3 patients with cirrhosis, portal hypertension and esophageal varices secondary to chronic hepatitis C infection. This effective and conservative regimen combines 3 potent antioxidants (alpha-lipoic acid [thioctic acid], silymatin, and selenium) that possess antiviral, free radical quenching and immune boosting qualities. C o n c l u s i o n : There are no remarkably effective treatments for chronic hepatits C in general use. Interferon and antivirals have less than a 30% response rate and because o f the residual viretnia, a newly transplanted liver usually becomes infected again. The triple antioxidant combination ofalpha-lipoic acid, silymarin and selenium was chosen for a conservative treatment o f hepatitis C because these substances protect the liver from fiee radical damage, increase the levels o f other fundamental antioxidants, and interfere with viral proliferation. The 3 patients presented in this paper followed the triple antioxidant program and recovered quickly and their laboratory values remarkably improved. Furthermore, liver transplantation was avoided and the patients are back at work, carrying out their normal activities, and feeling healthy. The autilor offers a more conservative approach to the treatment of hepatitis C, that is exceedingly less expensive. One year of the triple antioxidant therapy described in this paper costs less than $ 2,()00, as compared to mor than $300,000 a year for liver transplant surgery+,. It appears reasonable, that prior to liver transplant surgeQ" evaluation, or during the transplant evaluation process, the conservative triple antioxidant treatment approach should be considered. If these is a significant betterment in the patient's condition, liver transplant surgery may be avoided.

A

'~ Back2rolmct:There has been an increase in the number o f adults seeking liver

Key Words: Hepatitis C " Treatment • Antioxidant - Alpha lipoic acid" thioctic acid- Sitymarin • Selenium

Med Kli, 1999;94:Suppl 1II:84-9.

BACKGROUND
More than 20 years ago, when the author was in medical and pathology training at 2 hospitals in Cleveland, Ohio, he was assigned to 6 critical patients who were suffering fronl acute hepatic

thltegrative Nledical Centers of New Mexico and Applied Biology" (EPPWS I)cparm~cnt), N e w Mexico State University, Las Cruces. Ncx~ Mexico, USA,

recovered quickly. cirrhosis. and 8 glasses offiesh water. In this paper he will discuss the use o f this triple andoxidant regimen in the management o f 3 chronic hepatitis C patients. CASE STUDIES [] Patient 1 Mrs. A premiuln B complex vitamin was added to her regimen because alpha-lipoic acid depletes the bodv of . she became ve D' ~ltigued and nauseous. The abdominal distention was due to ascites. eine Lebertransplantation kostet im Vergleich mehr als $ 300. 400 IU o f vitamin E. Mrs. as measured by laboratory values and clinical parameters. the patients were prescribed 2 B-100 capsules a day. M. W e n n es eine beachtliche Verbesserung im Befinden des Patienten gibt. erh6hten das Niveau anderer fundamentaler Antioxidanzien und hindern virale Fortpflanzung.lin 1999. Germany. presented at our ofiqce last year appearing fatigued. Mrs. Eine Kombination y o n Alpha-Lipons~iure (thioctic acid). Illinois. She did not eat a nutritious diet and did not live a ve U healthy life stvle at that time. Fred Bartter (then C h i e f o f H y p e r tension and Endocrinology at the N a tional Institutes of Health) and the author were astounded by their recoveries and went on to treat many more mushroom poisoning patients. Because alpha-lipoic acid depletes some of the B vitamins. was told that the mass was probably cancer and that there was no hope. EinJahr der dreihchen antioxidanten Behandlung.m¢ Approach to thc l'reatnlcnt o(Hcplnns C Med Kiln l'~')'). however. Silymarin und Selenium wurde Gir eine konservative Behandlung yon Hepatitis C gewShlt.000 imJahr.94:Suppl III:84-9. 900 mg ofsilymarin in 3 divided doses (300 rag).rund: Es ~ b t im Allgemeingebrauch keine bemerkenswert erfolgreithe Behandlung von chronischer Hepatitis C. M. denn diese Stoffe schtitzen die Leber vor ffeier radikaler Besch:~idigung. Her AFP (alpha-fetoprotein) level became elevated (16. and a mineral supplement. About 5 years ago. and the seleniuln was encapsulated by Metabolic Maintenance Products Inc. [] Behandhmgsprogramm: Die dreifache antioxidante Kombination yon AlphaLipons~iure. die Patienten arbeiten wieder. silwnarin and selenium (selenolnethionine).. The 3 patients were selected at random fiom a group ofapproximatcly 50 chronic hepatitis C charts at the Integrative Medical Center of N e w Mexico in Las Cruces. and observed similar results. it is not clearly known whether the other regimens were correctly followed. only 4 oz or less of meat per meal. Aui3erdem wurden Lebertransplantationen vermieden. Schlfisselw6rter: Hepatitis C • Behandlung • Antioxidant ' Alpha-Liponsfiure • Thiotic acid ' Silymarin . Each patient was maintained on a dose of 6()() mg o f alpha-lipoic acid a day in 2 divided portions of 300 rag.'~l~dIC. Oregon. The patients followed the nutritional supplcment program carefhlly. Die drei Patienten. She did not improve. and take part in all exercise program that included at least a l-mile walk 3 times a week. The selenomethionine dose was 400 t. In spite o f their highly threatening condition the patients. She lost ahnost 50 lb of fluid in 1 month. sie erholten sich rasch. kostet weniger als $ 2000. weak.tg in 2 divided portions of 200 ug. and her abdomen was grossly enlarged. ALA) from the National Institutes o f Health and injected this antioxidant drug into the patients. ZUSAMMENFASSUNG Eine konservative dreifache antioxidante Methode zur Behandlung yon Hepatitis C. Dr. o f Sisters. and 400 btg of selenium a day. bevor eine Lebertransplantationsoperation in Erwiigung gezogen wird oder w~ihrend der Bewermng einer Lebertransplantationsoperation die konservative dreit:ache Behandlung zu erwiigen. portal hypertension.000 and 6. and was diagnosed with non-A. She was administered oral throsamide (40 mg) and potassium chloride (l I)meq) with a balanced diet and wholesome life style. non-B hepatitis. was treated with 600 mg o f oral alpha-lipoic acid in 2 divided doses (300 rag).Selenium . pale. She was treated with conventional therapies and continued to degenerate into a poorer state of health.1) and a mass was located in her liver. die in dieser Abhandlung beschrieben wird. each patient also took between 1. In addition. It was also suggested that the patients reduce their stress levels. The silymarin was a product distributed by N o w Foods of Bloomingdale. He ordered thioctic acid (alpha-lipoic acid.d necrosis secondary to hepatotoxic mushroom poisoning. About 3 years ago she was diagnosed with chronic he- patifis C. TILe silymarin dose was 900 mg per day m 3 divided portions o f 300 rag. P. Mrs. M. Es scheint vernfinftig zu sein. The author has recently added silymarin and selenium to tile regimen. P. die wesentlich billiger ist. P. Silymarin und Selenium: Drei Krankenberichte Hime(o. t~ihren ein normales Leben und Fdhlen sich gesund. folgten dem dreifachen antioxidanten Programm. und ihre Labo~verte verbesserten sich beachtlich. Over the years. die in dieser Abhandlung geschildert werden. and treated with steroids and interferon. Tile alpha-lipoic acid product was manufhctured by Asta Medica at Frankfurt am Main.Bcrks~m B M "Triple Anrioxid.0()0 mg of vitamin C. M. The patients were also requested to eat a daily diet that included at least 6 servings o f flesh vegetables and fruits.94:Suppi 111:84-9 O~ O. und wegen der zurfickbleibenden Vir~imia wird meistens eine neu transplantierte Leber wieder infiziert. Interferon und Virostatika haben weniger als eine 30prozentige Ansprechsquote. kann eine Lebertransplantationsoperation vennieden werden. esophageal varices. and throl-nbocytopenia. PATIENTS AND METHOD The 3 basic autioxidants that were used in this report are alpha-lipoic acid (thioctic acid). P. is a 57-year-old woman who aquired hepatitis C after a blood transfusion during surge W about 10 years ago. El SchluBfolgerung: l)er Autor bietet eine konservativere Methode zur Behandlung yon Hepatitis C. the author continued to treat additional patients with Other medical conditions using ALA.

F(gttre 4. t I. and selenitnn (400 pg) per day with supportive supplements. a liver biopsy was performed that showed moderate cirrhosis with active inflammation. she was anxious. Viral load in patient 2. 0. portal hypertension. 0 Mar-98 I Dec-98 I Mar-99 F(wre 2.re 5. her spleen was excised because it was lacerated. Figures 1 and 2 track the favorable changes in her ALT levels and her AFP levels. She was encouraged to follow a healthy life style program with a 2. she wanted to investigate a more conservative treatment regimen. and esophageal varices. S G P T (ALT) levels it.000 mg). She returned to college the next semester earning 215 120 100 80 o o 500 400 300 200 100 G ob 210 205 200 195 190 185 i o3 I ~ I ] I E 60 40 20 0 p-03 I r--. M. P. is a 49-year-old w o m a n who was infected with hepatitis C following a blood transfusion prior to trauma surgery more than 10 years ago. ~ I r'-. Mrs. tired. [ 03 I I co Z C3 ~ u. vitanlin E (800 IU). She was told that her condition was hopeless and that a liver transplant was her only option.-d supplements were also prescribed. L. Mrs. M. S G P T (ACT) levels in patient 1. She did not have Iwperglycemia prior to the hepatitis C infection. M. feels healthy. looks good. L. Triple Antmxi&mt Approach to the Treatment of Hepatitis C Mcd Klin 1999. L. Mrs. Within 2 weeks she began to feel much better and recovered quickly. M. and within 7 months regained her health.000-calorie diabetes diet. [3 Patient 3 Mrs. P. M. She became energized arm was able to do her normal work as a housewit). Mrs. was treated wkh interferon therapy without any satisfactory results. P. Mrs. To combat the anxiety and insonmia. and did not show an elevated AFP. went on to develop portal hypertension with esophageal varices. Mrs. P. . W h e n she presented to our office. biotin and other B vitamins. About 3 years ago. P. Figures 3 to 5 trace the favorable changes in her ALT levels. viral load and platelet levels. was put on our balanced health and lifestyle program. is working 8 hours a day.94:Supp1111. Mrs.'s fasting blood sugars were in the 300 m g / d c range. o~ I P-. was prescribed 600 nag of alpha-lipoic acid each day in 2 divided doses (300 nag each). Adequate amounts of vitamin C (2. L. and complained o f constant pain in the regions o f her liver and spleen. A F P levels in patie.5 mg ofaprazolam was 200 20 15 E 100' 10 50 Dec-98 Mar-99 Apr-99 Figure 1. Mrs. silymarin (900 rag). and insomnia. P. was added silymarin (900 rag/day) and selenium (400 btg/day). Three years ago she became ill and was diagnosed with cirrhosis o f the liver. was prescribed alpha-lipoic acid (600 rag). and pale. is a 35-year-old mother o f 3 children who developed hepatitis C secondat T to a blood transfilsion during the birth o f her baby girl 13 years ago. She never acquired thrombocytopenia because o f the splenectomy. She is free o f the signs and symptoms o f a serious chronic hepatitis C infection. P. and basic miner. Fi2.- P. prescribed.84~9 thiancin. M. Padent2 Mrs. P. P. as needed at bedtime. Phttelet levels in patient 2. She is doing very well today and is working at a arduous j o b and playing at sports without any fatigue or other symptoms o f serious disease. Her blood sugar fell into the normal range and the pain in her liver and spleen ended.86 Berkson BM. 03 I oo 05 I cO o~ I co 03 ~ oo (3") I o3 03 I o CE CO EL. she developed splenomegaly and thrombocytopenia. decided that prior to the liver transplant surgery. During surgery. Mrs. P. L.'s hepatologist sent her to the university hospital for liver transplant evaluation. 03 g 03 c3 O9 ¢0 o ± CO " CO Figure 3. patieut 2. P. As a result o f this pathology. Coenzyme Q10 (300 nag). anxiety. Her health continued to decline and she presented at our office with fatigue. As a result of the portal hypertension. To that. and is not tired. Today.

and alcoholic coma [23. SILYMARdN a 3. Diabetic neuropathy originates from a decrease in blood flow to various organs. It is a superb antioxidant that is soluble in both water and fat. It is also an important coenzyme for the glutathione peromdase detoxification system.8 grade point average (A). thus protecting the nerves from the toxic products of oxidation. and some studies used entirely sub-therapeutic doses [25]. This was accomplished by abolishing the products of lipid peroxidation and increasing the entrance of glucose into the cell [27]. These toxins damage the cell membranes by lipid peroxidation. In addition. In the late 1960's and 1970's. ALA brought about a significant reduction ofneuropathic symptoms in 23 patients [461. chelates copper [28]. In America. increases cellular glutathione levels and decreases tumor promoter activity [1. 20]. Because of this. National Institutes of Health studies reported the survival of 73 out of 79 seriously poisoned patients [3. Fastiuy. and drug overdoses [14. selenium . 30]. For many years. expeditious reduction ofbilirubm levels. DISCUSSION ALPHA-LIPoIC ACID Alpha-lipoic acid (ALA) is a small organic molecule with a disulfide bond. As of yet. there were several studies describing the successful treatment ofhepatotoxic nmshroom poisoning with intravenous ALA [22. interest in the use of ALA for hepatotoxic mushroom poisoning.371. Lately. Triple Antioxidanr Approach co tile Tr¢-auncnt of Hepatitis C Med Klin 1999:94:Supp1111:84-9 87 400 400 300 300 -~ 200 E IO0 0 I I J I I I -& 200 E IO0 0 I I I T I I 1 3-97 7-97 8-97 12-97 1-98 6-98 Figure 6. ALA is an imposant coenzyme f~)r the production ofacetyl coenzyme A. protecting the liver by neutralizing dangerous hydroxyl radicals. decreased their levels ofprocollagen III.. Silymarin is the mixed extract of the milk thistle plant (Silibum marianum) and has been used for hundreds of years as a treatment for liver disease. Ithas been demonstrated to be a proficient antioxidant. Dihydrolipoic acid (DHLA). It has been reported that ALA lowers the levels o£ E T O H metabolic breakdown products. In one study. 29. early cirrhosis. In the late 1960's and 1970's it was extensively used for serious hepatotoxic mushroom poisoning with excellent results [43]. superoxide ions and hypochlorous acid. The lipoic acid/dihydrolipoic acid redox couple inhibits viral replication by stabilizing the NFKB transcription filctor [4]. 13. 32]. 34]. hydroxyl radicals [39] and singlet oxygen [38]. Numerous other studies show that ALA is useful for the treatment ofdiabe- tes mellitus and syndrome X because it increases cellular glucose utilization [19] and significantly reduces insulin resistance [12. vitamin E. insulates the pancreatic islet cells from inflanmmtory assault [7]. prevents calcium oxalate ctTstals fi-om forruing in the kidneys [21]. and improved the histolog'y of their livers with daily oral administration ofsilynmrin [2. 47]. and in consideration of this ALA may be an effective treatment for alcohol induced hepatitis. 6]. ALA and I)HLA are superb tree radical scavengers themselves because they neutralize peroxyl radicals [36]. and stimulates the production of helper T ceils [15]. protects the kidney from aminoglycoside damage [35]. like ALA. Silymann. ALA is also a metal chelator that removes mercury from tissues [17]. 26. In addition. SELENIUM Selenium (Se) is an essential metal that is required for normal antioxidant metabolism_. was in the main lost. and shorter hospital stays [3 l]. 401. and liver disease in general. S G P T (ALT) levels in patient 3. there has been a gTeat explosion in ALA research. Alcoholic and other chronic liver disease patients lowered their liver enzymes. it's reduced fore< is an electron donor that recycles other fundamental antioxidants (vitamin C. however. Ethyl alcohol (ETOH) damages the liver by several mechanisms that ultimately lead to the proliferation of innumerable flee radicals. Figure 7. silymarin offers another effective treatment choice for serious liver disease. silymarin has been shown to be an effective antidote for toluene and xylene toxicity. Taking this intelligent reasoning into account. In this way silymarin neutralizes the toxins that destroy the cellular membrane systems and the hepatocyte's genetic nmterial [10. and glutathione).Berkmn BM. This results in an accunmlation of free radicals that can destroy nerve function. This effect is explained by the filct that ALA greatly increases glutathione levels in nervous tissue. inhibits thymocyte apoptosis [8]. Figures 6 and 7) trace her favorable progress. ALA was used as a treatnlent for liver disease. Due to ALA's lipophilic characteristics. Hulnan viral hepatitis studies with silymarin demonstrate quicker normalization of liver enzymes. reproduction and thyroid function. Both ALA and DHLA protect animals from neuronal death following laboratory-induced cerebral ischemia and reperfusion experiments [9. there are not many papers on this subject. because of the growing fascination with liver transplantation as a proposed "standard of care" treatment for serious liver disease. 16. it can cross the blood-brain barrier quite easily and can scavenge free radical toxins in the central nervous system. blocks the development of cataracts [24]. 4l 1. blood su2ar levels in patient 3. the toxic side effects of cancer chemotherapy can be attenuated with the use of ALA [5] and it protects bone marrow from free-radical damage secondary to ionizing radiation [33]. and removes arsenic [18].

Cao X. In: Faulst[oh H. ct al. the virus might become more active and produce more viruses that attack new cells. Frcc g.ect of silymarin t~i~ pla~m. Better V. Anlauli~a toxin~ a. T h e effect ofl)L-alpba lipoic ackl on }wavy metal intoxication in mice and dogs. Koikc I .esearch papers have reported that P. Ant[oxidant inhibition of thymocyte apoptosis by dihyth~tipoic acid. or during the transplant evaluation process.. I I. liver transplantation can be painfial. According to sevcral investigators this could give the immune system a chance to control the hepatitis C.lnitin. 14S:l I-7. Thiocdc acid in the treatnwnt ofptlisolling with . ct al..adicals l~. I)tabctcs 1996. Jayand~i S. Biochem l~hlrmacol I992:43: 211 I-5. Estrada D.43:1359-62. 43. et al. Zhang W.llpl~a-Anl.cted patients. Younossi Z.t ofsilymarin on chemical.ipoic acid mlproves iiCl%'t. Barttcr F.6:35:538-41. 3 9 Suzuki Y. Slater A. ct . 22.4: 373.tit 1982. Haugaard E.tlT F. a seleniu. It)81l: I%11-187. The anti-Amanita effect ofsltynlarm.d poisoning. Anlanita roxin~ and poisolfing. oxidative str¢¢. l'reatlllCllt ot'l"otlr ddayed IIlI. 32. eds. et aL The flee radical scavenger atpha-lipoic acid.tt'utc viral hepatitis. an anti-hepatotoxic tlavctmid tm 12-O-tetradecatmylphosbol-13acetate-reduced cpidcrnlal ornithine dccarboxylase activity :rod nlIZNA in SENCAP. disabling. et al. increase the levels o f other fundamental ant[oxidants. Biochem lqlimnacot 19. If there is a significant betterment in the patient's condition. encode selenium-dependent glutathione peroxidase genes.~95. Sandhya I).P. St. ct al.n deficiency could stimulate viral proliferation and thus promote thc progression of hepatitis C. o ( 1 ) k alpha-lipoic acid itl getat. Treatnlen~ o(alcohol related liver disease with dlioctic acid.~ levels O~'lll.. et al. 15: i099-1{13.tstroenterology [99S. Nilova T. Viruses might benefit from being directly involved in this selenoprotein encoding process by monitoring selenium levels in the cell. Free IC~dk als Biol Med 19'15:19:339-49. Alpha Iipoic acid prevents butathion¢ ~tt[~sxilnin¢-induced cataract ~.. (uric[tonal . The 3 patients presented in this paper followed the triple ant[oxidant program and recovered quickly from this potentially devastating viral infection.lI is~henlia. Takahara E. 171 : 17-2{1. Arzncm/For~ch 1995:45:872-4 2 I. . Jacob S. (. Arzncim Forsch 19!)3. ct ai.andomized controlled trial ofsilynmnn treatment m patients with cirrbosis of the liver.astroentcrot 1')82:17:5 l 7 +2 I..mlidc and vincristiuc su[t-~tc. Plomtcux ( . Shigcta K. and hnproves di'4ta] llcrve cotlductiOll hi experillleiital diabetic Ileumpatby |)iabct Care 1995. And in this way. 12. the newly transplanted liver ultimately becomes infected again [44]. ct a]. The endogenous cot~wtors.l]cctllar basis ofa Ullique roic t}sr selcnium. l}auer A.45:179g-gl)4 t 3. Intluence oF[blot:tic acid tnl the cbcmother. Scavenging o f reactive oxygen species by *ilibiniu dibenusucclnate. Interferon and ant[vitals have less than a 3()% response rates and liver transplantation is uncertain and tentative. Traitement des empoisonnements fimgiques phatloidinen~ en Tchecoslovaquie. 19. as compared to more than $ 300. Protective effect ot'kegakm in workers ex posed to orgatlic solvents. ElK'cts oflipoic acid on biliary excrctiou ofglutathionc and inctals. 6. 2 9 Palasciano (. et al.:hem 1975.et aI .mt ac6viqv ~Ssil~. Badell-lkldcn: Wirzstrock.'. that prior to liver transplant surgery evaluation..fl. 2. l )onohue M. Mo~ Cell Biochem 1995.d P. Thiocric (lipoic) acid: a dlcrapeutic nletal-cbet:mng alltil~xid:ll~t~ |~iocbcn~ Pharm 1995:51): t 23-6. R.hrl)oIII poisoniug p. 16. and interfere with virus proliferation. Stott [~.')rlnation m newborrl rats.cds. (hvcnanlyre. Hepatitis C related liver transpkults will skyrocket. Arch Pathol Lab Med 1999.9: t05-13. Hcpat'opi otcctor actil~ll tl~'qlvillariii Ill htlll/all . Sama S. 34.m N. 36. Tayk~r EW.adicals Kcs pm4:2tl:119-33 37. jindal S. Phamlacol l/. 4.1t. Anlanita toxius and poisoning. 31. Mira L. Triple Aiitioxtdaut Approach to the Trcatmel~t o{'Hcpatltis C Mcd Kiln 1999:94:Supp1111:84--9 neutralizes peroxides that proliferate under oxidative stress and consequently protects cell membranes from free radical damage.1.".lpcutic etI~cat:y o(cyclopho~ph.alterations or'tile liv. ~k.45: 249-56 41. cr al.ltlode~i~tetlcy ~irus mfi.ll Itljtuy alter ccrebr. P. lkainanadaan (iS et aI. et al. eds. Gregus Z. Acta Mcd Hung 1988. ct al. et aI. er aL Enhai~ccnlcnt ~fg{ucose di~posaI hi patients with type 2 diabetes by alpha-lipoic acid. Artloilla (). 1119:t 941-9. 14. It appears reasonable. Alpha Ittmic acid is all effective mhibltor of human illlllltlllodelltictlcy virus rclqicauon. Study o f the sel-tliii IcvcI ot'thioctic acid ill varillus diwascs j Vitammol 1%1:7:4s-52. Agents and Actions 1993. et al.222:583-6. This is partially due to the residual viremia. 9."I: 823-9. silymarin and selenium were chosen for a conservative treatment of hepatitis C because these substances protect the liver from free radical damage.. in that case.l. Badcn-lLidcn: Witzstrock. Studies oll lipoate ettk'cts on blood rcdox state m Ilttll/all itl/lllt. this conservative triple antio~dant treatment approach should be considered. Ou I'. ct aI.23:3(vS-711 lit. mice. Stimulation ofgktcose uptake by the natural coenzyme alpha-lipoic acid/thioctic acid. l~ustanlante J. One year o f the triple ant[oxidant therapy described in this paper costs less than $ 2. et al. Packer k Thioctic acid and dihxdrolipo~c acid are n o v d alltioxidants ubicb irlteract with reactive oxygen species. Bcrkson B.uuyciiI-induced ncphrotoxicity. ct al. 26. 123:143-5. Biochcnl Pharnlaco[ 1994:48: 753-9 27. Free Radicals P. 35. hit ILcs Ctmmluu Ny~t 1977:5:259.en E. Fuchs j. Furthermore. 45]. 42. Stein A. 20.ltopoi~. CONCLUSION There are no remarkably effective treatments for chronic hepatitis C in general use. Fintclmann V. 45. Berkson B.38:()0-5 8. The triple ant[oxidant combination of alpha-lipoic acid. Lipid pcroxidation and irreversible damage in rat hepatocvtc protection by the ~iiybiu-phospho-tipid complex [dis !1116. Marshall E.itlCllts rel clving king term H'eatlllcnt with psychotropic dr[Its. lt. Ncurosci Let[ 1994. Family Practice Ncv~s 1999:March I5:32. et al.Sties ill IlliCCbV lit'oit a d d [<. N A viruses. 44.J Hepato11989. Serbinova E. et al. "Hie cl}. Phannacokinetics oflipoic acid preparations and their effects on ATP synthesis. Ccleb Bltmd Flow Mctab 1q92:12:78 -S7 33. The author offers a more conservative approach to the treatment of hepatitis C. I)ibydrolipmc acid protects p. liver transplant surgery may be avoided. Cox A. Albrcdlt M. or HIV disease process [42.j AIDS Hunt IZetrovirol (in press). Selenium-dependent glutathione peroxidase modules encoded by I<NA viruses. processes ofmicrosomal and cytosole oxidation in human hepatocytes during tiver damage. IMlibitog" c t}i.es p. et al. Maitra I. I/. 1311. 23. et al. et . Selenium often combines with amino acids and forms selenoproteins. Phammcol Toxicol t 98% 52:78-82. Free P.. Et}-e. I5.rmmcrt It_. Stimulato W effccts ofsilybinm on D N A sytlthesis in partially hcpatectomized rat livers Non-response ill hepatoma and other malignant cell lines. et al.'ctofsitymarin. that is exceedingly less expensive.I (. Bitfl "['race Elcnient tkes (in pre~. Z KIm Mcd 1992.Itld reduces tlcttroIl. I g: 1161)-7. Wolli: N. 40.itlenls with t hioctic acid. Stiundarion of'glucose uti{izadon by tbiocdc acid in rat diaplwagm incubated m vitro. In: Faulstich [ l.llOlldialdehyde ill p. Biochem Biophys Acta 1970.47:87-92. et al. Kiln Wochen~chr 1991:69:722-4. (~arclnowncsis ] 994.mcrcatic islet ceils Ii'O/ll int]auuuaroQ attack.cs 1992:31!: 281-8. J Organ (.blotM time. 24. et at. To continue. Schotbr It. Med Kiln I973:68: 8119. Frcrick H. t9HI1:203-2111. et al kipolc acid aim dihydrohpoic acid :is ant[oxidants: A critical ¢valuariotl. Fereilci P. 1)ragoqcs B.dmi H. 111:FauMit:b H. Protects against cerebral iscbemia-rcperfiMon inju W m gerbils. the virus may remain in a dormant state for longer periods of time or remain permanently dormant. I. I)ihydrolipoit .l)h. If cellular selenoprotein levels fall. Harrcr T. If selenoprotein levels rise. Fhcrapy o(toxic liver pathologies with Lcgalon. Agraw. In view o f this concept. including hepatitis C virus. Log[nov A. Henrik.bm m vi~o dtlrillg 1tHiS[trill troll ovcrh)atl ill mrs (.'tlC tit. Nickander K.. 17. the addition of selenium might act as a "birth control pill" for the virus.. et al. Karkoutly C.s.ldiat P. 19.23: l(188-t)3.tilt[ morplaologic:d . Ammxid. Nagamatsu M. Oxidltion o(alpha lipoic acid. 25. S.000. this viral behavior could act as a barometer for increasing or decreasing viral reproduction. (~urr "Phcr Rex 1994.ldi~prtlt¢ctitlll oI'hctll.. 38.361 I-3. Garcia-Osuna M. ICm~akr~dm. Carrot I~. Agreenlcnt in pathologic interpretation of liver biopsy specinlens in posttranspknlt hepatitis C inti:ctilm. Graul l'L.. I S (. Haugaard N..5S:337-45. Consequently. thioctic acid and dihydrolipoic acid arc neuroprotcctive against N M I ) A and illa]OlliC acid lesions ofstriamm. 7. and thus slow down it reproductive mechanisms. reduce.lT. Effects of DE aipha-lipoic acid in glyoxylate-reduced acute litbiasis. Armwim Forvh 1')83:33:1286-8. and extremely costly. Ev~art H. Trkschler H. ct al.88 Berkm~ BM.I 5:225-63.s) . Toxicol Appl Pharnlacot 1992:1 [ 4:88-96.'r. Nutritiou H IV and drug abuse: tile rl/~. et al. et al. ct al. A double bhnd qudy. 3. Szilard S. it is entirely possible that a specific viral gene could generate a selenium shortage in the host. rsuchiya M. Arch Biochem Bi0phy~ 19t~lk86:1911-5.000 a year for liver transplant surgery. BadenBaden: Witzvtrock. Burkhart V. Vogel (. es I ')q2. Kubicka j. et al.'qIl:197-2112. Scand. Free Radica|s Bio[ Med 1995. Acta Mycol 1968. 31L 15ctrangdo A. Greene j. Catlavas ( .cs ColllllltliI P)ql . l~relm J.EFERENCES I. Postopvratives Verba|ten dcr Serumcholinestentse und andcrer Leberenzylne.4it:58-62. S. 2.

¢ds. Effekte ciner Therapie mit alpha-i ipons~iure gegentiber Vitanlin BI bci der diabetischcn Neuropathie. Las Cruces.. Ph. USA. In: Faulstich H. Triple Antioxidant Approach to the Treatment of Hepatitis C Med Klin 1999. 741 N. Mayer P. 1980:192-6. Amanita toxins and poisoning.Berkson BM. 47. 88005.com 171el'lO~ .D.2:443-8. The role ofthioctic acid in the treatment ot'Amanita phylloides intoxication. Ad&ess for Correspondence: Burton M. Diab Stoffw 1993. Zulik R.. et al. Integratiw"Medical Centers of Netv ~/[exico and Applied Biology (EPP~ZS DcpartNew Mexico State University. Kassay S. et al. Ziegler D. Baden-Baden: Witzstrock. Fon (+1/505) 524-3720 Fax -3721. e-maih burt~zianet. MS... New Mexico. Alameda Blvd.94:Supp1111:84-9 89 46. Berkson MD.