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Study: Vitamin D could help fight hepatitis C, Improve Peg/RBV Response
By Dan Even
Tags: Israel Health, Israel New
A new study has found that administering vitamin D to hepatitis C patients dramatically reduces the presence of the virus in the blood.
The study, carried out at Rebecca Sieff Hospital in Safed and Hillel Yaffeh Medical Center in Hadera by Dr. Assy Nimer and Dr. Saif Abu-Mouch covered 90 hepatitis C patients.
The findings were presented in late November at a conference of the American Association for the Study of Liver Diseases.
For six months, in addition to the standard treatment, which included Interferon once a week and a daily dose of the antiviral drug Ribavirin, 30 patients were also treated with 1,000 units of vitamin D a day. A control group of 60 patients went without the vitamin.
In order to assess the impact of vitamin D on the treatment of the disease, before starting the study, all patients, including those from the control group and those who were found to have a vitamin D deficiency, were given supplements, so that all participants began the study from the same point.
A month after the start of treatment, the virus had disappeared from the blood in 44 percent of the group receiving vitamin D supplements, as opposed to just 18 percent among the control group.
After three months, the success rate for the group getting the supplement rose to 96 percent, compared to 48 percent in the control group.
Other findings from the study, which will be presented next month in Kfar Blum at a conference of the Israeli Association for the Study of the Liver, indicate that this trend continues even after the end of drug treatment.
The initial results show that six months after the end of treatment, 90 percent of patients treated with drug therapy and vitamin D supplements had the virus disappear and completely recovered.
"The drug treatment for hepatitis C patients is usually administered for around a year, and occasionally the virus disappears from the blood, but remains in other places, for example, in the liver and lymph glands," explained Nimer, the director of the Liver Disease Unit at Rebecca Sieff Hospital. "At the end of the treatment, the virus may return to the blood, but we found that in patients who were also given the vitamin D supplement, the virus did not return, that is, it was excreted by the body."
How vitamin D helps improve the condition of hepatitis patients is not entirely clear. However, according to Nimer, "It has already been proven that vitamin D benefits the immune system by increasing the activity of T cells [white blood cells that help in the fight against pathogens], improves the body's reaction to the insulin hormone, and reduces the level of pro-inflammatory proteins that cause liver infections caused by viruses."
The findings have important ramifications, mainly in light of the difficulty in effectively treating all patients with hepatitis C, a disease that has become the leading cause of cirrhosis of the liver and the need for liver transplants, and thereby the number one cause of liver cancer.
It is the only form of hepatitis for which no vaccine has been developed yet.
"The proteins surrounding the virus change constantly and it is difficult to create a vaccine against it," Nimer said.
There are some 300 people believed to be living in Israel with hepatitis C and receiving drug therapy. World Health Organization data indicates that this is an infectious disease with global reach: in the United States, 2 million-4 million patients are diagnosed annually, 5 million-15 million patients in Europe, and 12 million patients in India. Most of them are unaware they have been infected and are not receiving drug therapy, which increases the risk of a worsening of liver function.
There is also an incidence of disease in Japan, where some 350,000 new cases are diagnosed annually, and in Egypt, where 20 percent of blood donors are rejected as carriers of hepatitis C.
The virus is spread primarily by coming into contact with tainted blood, either through blood donation or unsterilized syringes, mainly among narcotics users.
The risk of being infected during unprotected sex is low - around 2-3 percent.
In recent years medical literature has highlighted vitamin D as effective in reducing the risk of various diseases, including infectious diseases, diabetes and even breast cancer, prostate cancer and colon cancer. It also increases the effectiveness of treatment for cancer patients.
An article published in 2006 suggested the possibility that a vitamin D deficiency during the sunless days of winter is the cause of flu outbreaks and increases the risk of respiratory illness in children, even though articles published later countered those findings.
Let the sunshine in
Vitamin D is absorbed from the sun's rays, but according to recently conducted studies over the past few years, even in sunny Israel, a substantial part of the population suffers from a Vitamin D deficiency.
A survey conducted at Rambam Medical Center in Haifa found that there is a severe shortage of vitamin D in the ultra-Orthodox community due to their modest dress, which shields most of the body from the sun's rays.
A survey conducted a year and a half ago at the Kupat Holim Meuhedet health maintenance organization, which checked vitamin levels in the blood in children up to the age of 19, found an average level of 22 nanograms per milliliter of vitamin D. This amount is only two-thirds of the recommended level (32 units).
In the ultra-Orthodox Kiryat Sanz neighborhood in Netanya, an especially severe shortage was found, with an average of 18.5 units. However even in the Jerusalem neighborhood of Baka, which is partially secular, the average level measured was still only 29 units.
About two years ago, Prof. Sophia Ish-Shalom of Rambam found that young high-tech workers also have a vitamin D deficiency, due to the many hours spent working in offices during daylight hours.
Around 5-10 percent of vitamin D levels are obtained from foods, especially salmon, sardines, mackerel, cod, tuna and egg yolks. Vitamin D levels are measured in international units.
At the U.S. National Academy of Science's National Institute of Health, the recommended daily consumption is 200 units of vitamin D up until age 40, 500 units from age 51-70 and 600 units from age 71 on.
Many experts argue that the recommendations are too low, and the issue is under discussion in professional medical associations in the West.
In recent months, the Health Ministry has begun promoting a plan to increase vitamin D levels among Israelis, by enriching milk drinks, approving the import of nutritional supplements that contain vitamin D in higher doses and increasing awareness of the importance of the vitamin among pregnant women and among children, among other tactics.
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