Preventing or Managing Drug
Side Effects
by George M. Carter
It takes guts
In the previous article, we
reviewed the effects both HIV and the drugs can have on the
body in general terms. Now let’s turn to the guts of
the problem: what doctors call gastroenterology. This field
of medicine studies the structure and diseases of the stomach,
intestines, esophagus, liver, gall bladder and pancreas. Each
of these organs can suffer serious problems resulting from
HIV, opportunistic infections (OIs) or the medicines used
to treat them. Here, we briefly tour the body from mouth to
butt.
This is just a brief overview.
The suggestions here are based on the philosophy of first
trying interventions that are the least toxic/most helpful
to the body, then using more toxic, costly drugs. Every body
is different, so it may take some experimentation to find
the best approach for you. If the situation is serious, going
directly to standard medical intervention may be best.
Mouth
Your GI tract actually starts
with your mouth. As food enters, digestion begins: saliva
is produced, you chew (thoroughly!) and swallow. But watch
what goes in your mouth. Aside from the joys of oral sex,
studies show people with HIV take in more calories. Higher
levels of fat in the blood (cholesterol, triglycerides) make
watching what you eat all the more important. Diet will be
discussed in more detail in the forthcoming article on lipodystrophy.
In general, try to limit the amount of junk food, colas, etc.
Eat more whole grains, fruits and vegetables. If you eat meat,
more deep sea fish and broiled meats and less fried ones.
Prepare good food well and enjoy it. Indeed, addressing diet
is part of handling many of the problems discussed below.
People with HIV often have
gum and/or teeth problems. These should be closely watched
and treated. Brush often and floss. Consider placing your
toothbrush in a solution of hydrogen peroxide to keep it free
of bacteria. Get sores (like cold sores or herpes) diagnosed
and treated.
In order to eat anything,
you have to want to. Sometimes, though, your appetite may
be put off by HIV or the drugs. You need to eat. There are
a variety of ways to stimulate your appetite. Marijuana or
the drug Marinol is one way, but this is not for everyone.
Herbs classified as bitters include gentian and dandelion.
They stimulate gastric secretion and have a long history of
safe use for stimulating appetite. Cinnamon, coriander, Iceland
moss and fenugreek have all been used to help increase appetite.
Also, certain nutrients like B vitamins, carotenoids and zinc
along with carnitine can help an impaired sense of smell or
taste which might diminish your appetite. You should also
avoid smoking or consuming caffeine before eating as these
can reduce your appetite.
Intestines, large and
small
From the stomach, the digesting
food and fluids go into the duodenum, the entrance to the
small intestine. The pancreas produces enzymes that help to
further break down food. The environment shifts from the acid
of the stomach to the alkaline environment of the intestines.
Food is pushed along and nutrients are absorbed by little
hair-like structures that line the small intestine known as
villi. It then goes into the large intestine where fluids
are absorbed and the fibrous part gathers together to form
great big honking turds that eventually wind up in the toilet.
Villi are damaged by HIV which
hangs out in the lymph system. The lymph system includes a
network of vessels like those that carry blood and are found
inside the villi. The Gut-Associated Lymphoid Tissue (GALT)
is one of the largest parts of the immune system, containing
40-60% of lymphocytes and a huge reservoir of HIV. Infections
like CMV, candidiasis as well as medicines can cause a condition
known as villous atrophy, where the villi become stunted.
Normally, these hairlike projections “turn over”
or develop anew every 5-6 days. If the villi are stunted,
you have less absorption of nutrients. Which is one of the
reasons many studies have shown that the levels of vitamins
and minerals are lower in people with HIV and get even lower
by the time AIDS develops. One way to deal with this is to
use the amino acid glutamine. Studies of surgery patients
show that further damage to villi can be halted by the addition
of glutamine. A dose of 20-40 grams a day may be needed.
Another problem that can arise
is the loss of bacteria that the intestines need. These good
bacteria may be wiped out when antibiotics are used. Supplements
of acidophilus and bifidus (sometimes found in fortified yogurt)
can help to restore this balance. Just remember to wait a
couple hours after taking an antibiotic or you’ll eliminate
their benefit!
One very important problem
that can arise with drugs and infections is an increase in
gas and flatulence. The first thing to do is address your
diet. Find out if you have a lactose intolerance (and avoid
dairy or take a lactaid type product). Some beans are not
known as the “musical fruit” for nothing, while
others, like aduki or garbanzo beans, may result in less flatulence.
A variety of herbs can help.
Gentian, peppermint, allspice, anise, ginger, lovage and lavender
have all been used to reduce farting. Mixtures of Chinese
herbs known as DigestEase or Quiet Digestion (from Health
Concerns) may provide relief.
Liver
The liver is one of the largest
and most important organs in the body. It fills up the area
on your right side from under the lower part of your ribs
curving down toward your pelvis. The liver has many functions,
including filtering and sorting absorbed nutrients and drugs
(metabolism), helping to detoxify drugs, synthesizing and
secreting proteins, bilirubin metabolism and glycogen storage.
Damage to the liver is assessed
in various ways. Commonly, one sees an increase in liver enzymes
such as ALT (SGPT) or AST (SGOT). Other blood markers of liver
function include alkaline phosphatase, bilirubin, albumin
and GGT. In addition, it is important to get tested for hepatitis
virus infections. If you haven’t been exposed to Hepatitis
A or B, get a vaccine. There is no vaccine for Hep C yet.
Many drugs damage the liver.
The most important and common is alcohol. All the HIV drugs
can damage the liver. Norvir (ritonavir) is one of the worst
offenders, causing severe hepatotoxicity in 30% of users as
opposed to 10% overall for those using other drugs.
There are a variety of natural
interventions, many of which have undergone some human clinical
testing. The best and safest of these is the herb milk thistle
which contains silymarin. Other liver helpful herbs include
the licorice extract glycyrrhizin (it may increase your blood
pressure or reduce potassium; eat more bananas), picrorhiza,
dandelion, schizandra and Reishi mushroom. Vitamin E (800
IU of mixed tocopherols per day), omega-3 fatty acids, N-acetylcysteine
(NAC), lecithin and alpha lipoic acid have all been shown
to improve liver function. Another Chinese herbal formula
known as Ecliptex (from Health Concerns) helped reduce this
author’s liver enzymes to normal levels.
Gallbladder
This organ is nestled in the
liver. It produces a concentrated form of bile acids (sent
in by the liver), which it releases into the duodenum (in
response to cholecystokinin) as part of the digestive processes.
Protease inhibitors may increase
the level of bilirubin in the blood. (Bilirubin is the yellowish
pigment in bile associated with jaundice.) While it’s
generally not bad enough to stop the drug (except perhaps
in infants and kids), this should not be ignored.
The first thing to address
is diet. Cut down or eliminate greasy foods. However, eliminating
fat is not a good idea, so get the right amounts of “good”
fats. Plenty of fluids taken in daily is vital, filtered water
being the best fluid! Fiber, particularly from oats, may also
help as it improves digestive functioning. The herb fumitory
has been used to treat gallbladder discomfort. Artichoke and
curcumin have been used to improve bile flow from the liver
into the gallbladder as well as for lowering cholesterol.
Peppermint leaf tea may also help (but not peppermint oil).
If your gallbladder has been removed or you have persistent
trouble with low bile output, bile salts may aid digestion.
Gall stones come in different
varieties: brown, black and cholesterol stones. Some have
suggested the use of apple juice or apple cider vinegar (diluted)
to help soften stones. This can be followed by a lemon juice/olive
oil flush to get rid of them. The problem, however, is if
the stones remain somewhat large and get stuck in the bile
ducts, surgery may be needed. Others suggest using epsom salts
before the oil/lemon to open the ducts. Foods that might help
include apples, cherries, grapes, carrots, apricots, leeks
and tomatoes. Standard interventions include ultrasound and
surgery, along with weight loss and eating less saturated
fats.
One thing to avoid if
you have gallbladder attacks is coffee—with or without
caffeine. It causes contractions. Herbs to avoid when you
have stones include artichoke leaf, boldo leaf, cardamom seed,
chicory, devil’s claw root, ginger root, peppermint leaf
and oil and turmeric root. Excess weight, estrogen, female
gender and older age are risk factors.
Pancreas
The pancreas is a long, wrinkly
organ located just below the stomach. Its two main functions
are endocrine and exocrine activities. The endocrine functions
relate to the release of insulin to help the body handle dietary
intake of sugar (like glucose). The pancreas also secretes
enzymes into the duodenum which further helps the body to
break down foods; this constitutes its exocrine function.
Pancreatitis can be acute
or chronic. Symptoms can include pain, fever and, in more
severe cases, intestinal obstruction, low blood pressure and
heart problems (tachycardia). The acute form may be caused
by alcohol, pancreatic cancer, passage of a gallstone, drugs
like ddI or sulfonamides, infections like CMV or EBV as well
as hyperlipidemia. The chronic form may be caused by alcohol,
heredity, aging, cystic fibrosis, among other things. Severe
forms can be fatal.
We also know that HIV
drugs can cause insulin resistance, and can increase the risk
of diabetes (along with being overweight), which can be a
hallmark, along with pain and weight loss, of chronic pancreatitis.
Aside from levels of amylase in saliva and other blood tests,
various imaging techniques (like CT scans) may be used to
diagnose pancreatitis.
The first best treatment is
to stop drinking!
Pancreatic enzymes are often
prescribed in cases of chronic pancreatitis to help offset
the loss of such enzymes during an attack. A good basic antioxidant
program may help reduce inflammatory responses damaging to
the pancreas—but this probably has its best effect preventing
the problem, so start early.
The real poop
At the end of food’s
journey, a fair amount ends up in the toilet, of course. But
don’t just flush it, check it out. It should be a nice,
medium, dark brown color and good consistency. Lighter, grayer
or yellowish stool may indicate liver or gallbladder problems.
Very dark brown or black stools may indicate other problems
such as blood or liver problems. These should be carefully
evaluated.
You’ll know if you have
diarrhea. And there are a lot of things you can do to help
minimize it. First, though, get a proper diagnosis to eliminate
parasites (Giardia, for example) or other problems. For many,
diarrhea happens after starting the protease inhibitor drugs.
There are many ways to address
diarrhea, including diet (BRAT: Bananas, Rice, Applesauce
and Toast) and the amino acid, glutamine. Herbs that have
tannins help control diarrhea and include green or black tea,
bilberry, agrimony, blueberries (fruits or leaves), raspberry
leaves and savory. Certain forms of fiber like psyllium or
oats are very important. Vitamins such as A (beta carotene)
and E with selenium are important. If these don’t work,
then consider drugs like Imodium, etc.
George M. Carter is the
Director for Treatment Information Development for DAAIR in
New York City. He has been managing his hepatitis C infection
solely (so far) through the use of micronutrients and herbs.
(©1999 by George M. Carter)
|
