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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”

Connection between Hepatitis C Virus & Anger?

November 6, 2000
Update on Hepatitis C from the AASLD

Harm Reduction Conference . 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 Hepatitis C Virus 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 Hepatitis C Virus patients without cirrhosis, all of the Hepatitis C Virus 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 Hepatitis C Virus 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 Hepatitis C Virus 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 Hepatitis C Virus, 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!

HepCBC -