We've Got Hep C and We're Mad As Hell!
November 2000's Advocate:
We've Got Hep C and We're Mad As Hell!
Is There A Connection Between Anger and Hepatitis C?
By Joan King
President HepCBC
I don't know about you, but I've never run into a group of "unreasonably" angry
people in my life like some of those I have encountered in Hep C support groups,
both "live" and on the internet. Don't get me wrong. Some of these people are my
best friends, but I can't but help feeling there is some sort of physiological
connection there. And to be fair, I'll even include myself. Have you felt
yourself reacting in a way that you know is illogical? I sure have, especially
before treatment. I did a search on the internet to see what I could find.
Indeed, I found several sources that linked anger with a diseased liver, and the
sources were both holistic and medical. The holistic view is that anger is a
negative emotion that can get stuck in the liver, especially a liver that isn't
functioning well.
The medical point of view is that hepatic encephalopathy, or brain and nervous
system damage caused by liver disorders, can cause changes in consciousness,
behaviour, and personality. It can even cause coma. It can also cause
forgetfulness, confusion, disorientation, delirium, dementia, loss of memory,
intellect, reasoning, changes in mood, decreased alertness, daytime sleepiness,
progressive stupor, decreased ability to care for oneself, loss of small hand
movements, muscle tremors, seizures, speech impairment, a strange musty odour to
the breath and urine, and, well, you get the idea. An EEG will show
characteristic abnormalities, and blood tests can confirm this phenomenon. No,
it's not your imagination.
No wonder we're angry! The severe symptoms are usually experienced only with
cirrhosis, but two research groups have recently reported that HCV can affect
the brain in people with less advanced disease, even with mild fibrosis. This
disorder was not just related to hepatic encephalopathy. In an Austrian test
comparing 58 healthy subjects to 58 subjects with HCV patients without
cirrhosis, all of the HCV patients showed a "subclinical neurophysiological
impairment." So maybe my observations aren't a figment of my imagination. The
other study, done in the UK, reported that those with HCV scored worse in
"physical and social functioning, energy and fatigue, and other measures," and
ruled out any effect of previous IV drug use. Interestingly, the researchers
found that patients with mild Hep C were slower in memory tests, but just as
accurate as healthy subjects. A test was done in the US on both HCV positive and
negative drug users, and those with Hep C scored higher for depression.
So what causes the anger? Is it all physiological? Maybe some of it is related
to dealing with a possibly deadly disease. It may be related to the fatigue or
depression caused by Hep C.
What is the mechanism that allows the brain to be affected in liver disease? In
the case of people with cirrhosis, the liver can no longer convert ammonia, so
it collects in the brain. Ammonia is produced by the body when protein is
digested. The blood no longer circulates through a diseased liver where it would
usually be filtered and detoxified. Toxins can damage the brain and spinal cord.
Encephalopathy can be triggered in people with stable liver disease by several
things: loss of blood, too much protein, electrolyte imbalances, especially low
potassium levels caused by vomiting or diuretics (eat your bananas!), draining
of abdominal fluid, anything that causes alkaline blood pH, low oxygen levels in
the body, medications such as barbiturates, tranquilizers, surgery, or any
illness.
There is a theory that hepatitis C virus may actually invade our central nervous
system. Some brain cells normally die and are replenished by circulating
monocytes (a type of white blood cell), as many as 30% a year. These monocytes
can possibly by infected with Hep C and make their way into the brain, attacking
the brain cells and causing neuropsychiatric symptoms. Scary! But this is just a
theory. Post-mortem tests are now being done in London on brain tissue.
Researchers also suggest that the virus may hide in the brain, where it is safe
from attack by antiviral therapy. There seems to be no relationship between the
severity of hepatitis and the cerebral symptoms.
All this sounds very discouraging. So what can we do? If we are constantly
exploding with rage, we will alienate our family members, friends,
co-workers.... First of all, when we are dealing with our friends with Hep C, we
can try to be patient. We can show this article to our significant others, and
hope they will understand better. People usually are more prone to anger than
usual when taking interferon. Information can help arm us. Then we can start to
take action.
Watch your diet:
First of all, don't drink alcohol! Watch your proteins, especially if you have
cirrhosis. A high protein diet may cause increased levels of ammonia. Try to get
your protein from vegetable rather than animal sources. Keep your blood
alkalized and blood sugar levels stable by eating a high carbohydrate, low fat
and protein diet. Eating bananas and whole grain foods promote relaxation and
sleep. Foods with soy protein and eggs lead to alertness.
Eat your biggest meal in the early part of the day to avoid restlessness and
insomnia. It's good to keep a journal to see how your eating habits relate to
your emotions, moods, and physical health. Avoid preservatives, additives,
colours and illegal drugs or legal drugs, or at least use the smallest dose
possible. Sugar is a drug which leads to fat storage. Fructose may be a better
choice. Eliminate white flour products, fried foods, processed or fast foods,
pasteurized and homogenized dairy products, antibiotic and hormone fed animals,
addictive substances of all types, and chlorinated or fluoridated water.
Alter your lifestyle:
Smoking by the patient, or even smoke in the atmosphere, will increase measured
levels of ammonia. Did you know that one cigarette smoked 1 hour before a blood
test will increase the blood ammonia?
Avoid all toxins, antacids, any medication with ammonium, and if possible,
sedatives and tranquilizers. Things like chiropractic, acupuncture, yoga,
breathing exercises, visualisation, and/or meditation can help ease your stress
levels. Just like your mother said: Get as much exercise, fresh air and sunshine
as you can.
Calming audiotapes or CDs can help, and there are some good ones with positive
self-talk. It's important to maintain a positive, happy attitude. Try
stress-reducing herbs such as chamomile, thyme, lavender, lemon balm, calendula,
marjoram, peppermint, rosemary, and St. John's Wort, (there are warnings about
taking St. John's Wort with other anti-depressants) in reasonable amounts, and
after consulting with your doctor.
Channel your anger into something positive, like letter campaigns for more
clinical trials, and volunteer work.
Get medical help. At present there is not much the medical profession will do to
help with subclinical neuropsychiatric complications of HCV, since many doctors
do not recognize them as such. If, however, you are suffering from clinical
(more serious) encephalopathy, your doctor can be of immense help. What can a
doctor do to treat encephalopathy? Lots! Blood loss can trigger brain fog. The
doctor can stop blood loss from gastrointestinal bleeds with endoscopy and
cauterization. To get rid of the toxins like ammonia that collect, the physician
can prescribe laxatives, such as Lactulose, and enemas. A reduced- or no-protein
diet may help, but this is not for everyone. Tube feedings may be necessary, and
Neomycin can reduce ammonia production by intestinal bacteria. If the Hep C is
"cured" with interferon or interferon plus ribavirin, this stops the
inflammation and fibrosis, and, of course, the brain fog. (It can even clear up
early cirrhosis.) Yes, the side effects are uncomfortable, but so is end stage
liver disease. Even if you don't get rid of the virus, the interferon can slow
the progression of cirrhosis. Brain function seems to normalize with antiviral
treatment. In the meantime, the doctor can prescribe antidepressants for those
on treatment, where absolutely necessary, since the treatment itself can cause
emotional disorders. Successful transplantation will take care of brain fog, but
the anti-rejection medications can cause mood swings and anger. Get counselling.
One last note: Please, if you notice any change in your mental state, or in any
of your neurological functions, call your doctor. Hepatic encephalopathy can
rapidly become an emergency condition!
Reprinted by permission - HepCBC - visit their website: www.hepcbc.org
References:
HEPATIC ENCEPHALOPATHY
http://members.aol.com/HCVWD/he.html
HCV and Brain Dysfunction, by Jules Levin
http://thelab.upmc.edu/UTSO/A/ammonia.htm
Hepatic Encephalopathy
http://accessatlanta.adam.com/ency/article/000302trt.htm
Healing Sounds
http://thelab.upmc.edu/UTSO/A/ammonia.htm
Healing the Liver (Anger)
http://www.theflow.org/qigong/liver.htm
http://www.ncbi.nlm.nih.gov/
From Martial Arts of China presents Chi Kung Issue 1, 1991, Page 17 Courtesy of
Shaolin Brand
http://infinite.org/library/pages/SBMACCK-17.html
PROMOTING HEALTH AND VITALITY THROUGH FOOD
http://community-2.webtv.net/essentialhealth/EMOTIONALHEALTH/
Your Body's Wisdom, by Teshna Beaulieu, DC
http://www.newvis.net/f99-9.htm
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