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Thursday, January 27, 2011

Antiviral Therapy 101, Part 3

I was asked why there is a concern with viral mutation if the dose isn't high enough.  I thought I would share my answer.  Here it is:

My explanation for this is long, bear with me. 

I can't give a full-blown scientific explanation but I can try to explain it in layman's terms as I understand it.  Now, keep in mind that this is all from Dr. Goldberg.  I don't know why DAN or other lower dosing protocols don't feel the same way so I have no way of even guessing if they may be wrong, right, or somewhere in the middle.  My own DAN even thinks that 2x is usually sufficient with no viral mutation but is not opposed to 3x a day and does see benefit.  But I can guess why they might think 2x a day is fine, and that is half-life, which is the basis for all medicine dosage.

We'll use Valtrex as our example.  The half-life of Valtrex is approximately 4 hours (some studies say more, some say less so 4 is about what I call the average, again, no science involved in my conclusion on that).  And also understand that when looking at half-life, the amount of drug in the system doesn't simply drop in equal numbers by the hour.  You don't start off taking 1000 mg and in 4 hours you have 500 mg in the system and in 7 hours you have 250 mg.  And this is probably why there is differentiation in results of half-life, there are other factors that come into play.  Again, I'm not a scientist and I have no idea how half-life really works as a function.  I only understand it as a concept.  Half-life simply means how long it takes for half the medicine to be gone from your system.  It doesn't necessarily mean that that is half the time it takes to leave your system.

But before we go on to why half-life is important, we need to look at how the medicine works.  It works by inhibiting replication.  Different antivirals do this in different ways but this is the outcome:  viruses can't replicate.  

Viruses, are not living organisms, just strands of DNA or RNA with a hard outer shell - they don't even qualify as being a single-celled organism.  Anyway, they inject themselves into host cells and hijack the replication system, encoding themselves into your DNA (maybe not exactly like this but again, layman's terms) and that's how they replicate.

Antivirals stop this process but they only work for as long as the drug is in the system.  I'm not sure what the threshold is for how much is necessary to have in the system for it to work.  Could be 500 mg, could be 5 mg, I don't know.  But think of it like this.  We know there are thresholds for something to work.  We know that underdosing an antibiotic will not kill the bacteria you are treating.  The same applies to supplements.  If you take 5mg of Vitamin C a day, it's not likely going to do anything but waste the time it takes to take the capsule and your money buying the bottle.  There's no effect until you reach a minimum amount of vitamin C a day.

So now we get back to half-life.  You want to keep enough of the drug in the system to maintain a workable dosage in the body.  In NIDS, they want to keep a higher amount to ensure it's inhibiting replication.  Here's what I think might be going on with DAN.  Because the half-life is about 4 hours, they may be assuming that every 8 hours is sufficient, they aren't concerned by the minimum threshold amount for it to work.  They just want you to take it at about the time the drug is almost completely out of the system.  NIDS isn't taking that chance.  It exponentially increases the amount of drug in the system so that by the time you go to bed, you have enough in the system to make it through the night without running out.  (Now, keep in mind that I said I don't know the mechanics of half-life.  So I say exponentially but I don't truly know that that happens or the mechanics of it.  It might not be exponentially increasing the amount of drugs you have in your system, just like it does't exponentially decrease.)  With DAN, you are taking it once in the morning to get you through the day and then once in the evening to get you through the night.  

Now, in my mind, if the life of a drug is approximately 8 hours (could be more, could be less because remember the above exponential problems we have, but we are just going to assume 8 for the purpose of trying to explain).  There are 24 hours in the day.  Taking it twice a day only covers 16 with a possible extension of maybe 4 hours but I find it hard to believe that it will cover a full 24 hours).  In 3 times a day, you have overlapped dosage before the dose runs out, so there is more in the system and this extends the length of time it's going to be in the system, hopefully covering the full 24 hours.  Now I could be totally wrong in my understanding of this.  I do not claim to have the answers.  It's just my understanding and my working my way around the information I understand, which granted, I may only think I understand.

So how does this affect viral mutation?  Simple.  Viruses mutate.  When you allow replication to restart, that gives them an opportunity to mutate because that's when mutation occurs - replication.  The same is true of anything.  The cells in your body don't just mutate as they are in your body all whole and complete and doing their job, they mutate during replication.  The same is true of bacteria and the overuse of antibiotics.  

By dosing 2x a day, you are leaving a gaping window of opportunity for replication.

Here's the thing about mutations.  Everything mutates, viruses, bacteria, cells, DNA, everything.  New flu strains come up every year, babies are born with genetic defects, etc.  Viruses aren't actively thinking, "I need to mutate to form a resistance to a drug."  They just mutate.  And because of the specificity of how antivirals inhibit replication, they can mutate themselves into drug resistance.  Antivirals can work simply by changing one little tiny protein that disrupts their current method of replication.  One mutation that doesn't involve that protein and it's resistant because antivirals are so specific.  Any tiny mutation could lead to resistance.  And the less complex the thing, the more significant the mutations can be.  This is why you don't see babies born with six toes every single day, in every single hospital. We are too complex and mutations within us aren't always so major or even remotely significant.  

There isn't much info on antivirals, stealth viruses and mutation with autism, of course.  Where you tend to find the information on viral mutation with antiviral use is in the places where it is life threatening, namely - AIDS and other immunocompromised illnesses that have any potential to be fatal.  Most of the research done in this area is on AIDS patients.  Typically, when AIDS patients find that the antivirals don't work - it's not always because they are dosed wrong, but because as patients, they aren't taking it as directed.  They are skipping doses.  Of course, that's not the only reason, but it is major reason and a very important reminder that one must take these drugs appropriately if they are expected to work.

Is DAN right in 2x a day, is it sufficient?  I can't say.  I can only tell you that this is how I've worked it out in my mind and I tend to think that 2x a day is generally not sufficient.  Since there are kids getting benefit from it at 2x a day is simply more proof that we just don't know.  Doctors Rx antivirals as low as 1x a day for some illnesses.  So the answer is really still a mystery to me no matter how I work it out trying to apply logic when I really don't know all the facts.  But this is the conclusion I came to.  And this is why, even though I no longer see a NIDS practitioner, I still choose to follow the NIDS dosing.

I have no idea if that helped or not.  And if anyone has anything to add or correct or clarify, hop on pop!

So that's my story.  I'm not sticking to it if you have something better to tell me.  You know where the comments are and my mind is always open.

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