Nutrition, cirrhosis and encephalopathy study

[mhudnall]

I posted this in another thread, but I think its good info so I started a thread of its own.

I was hoping that all the cirrhotic patients on the board have heard of branched-chain amino acids.

Branched-chain amino acids, or BCAAs have great studies behind them as a source of protein that cirrhotics benefit from and tolerate well. They are valine, leucine and iso-leucine and you can get them at GNC.

Go to pubmed and check out branched-chain amino acids and end-stage liver disease.

There are other things that would help, for instance phosphatidylcholine for your cell membranes and N-acetylcysteine for glutathione replacement.

Also google mitochondrial nutrients - B complex, betaine folic acid, alpha lipoic acid, etc. because HCV beats up your mitochondria.

All that should be taken in consideration of any meds you are on however

From Pubmed, A recent study came to these conclusions regarding the:

Dietary Management of hepatic encephalopathy revisited

This study illustrates some new conclusions regarding dietary management of advanced live disease, and this is study was just published:
1. reduction of protein intake is not useful for hepatic encephalopathy
2. oral supplementation of branched-chain amino acids has a role not only for its nutritional effect in cirrhosis per se, but also for its effect in reducing the risk of recurrence of hepatic encephalopathy
3.alterations in gut microbiota develop in parallel with decompensation of cirrhosis, and modulation of gut microbiota may be effective for treating and preventing hepatic encephalopathy
4. prebiotics and probiotics are useful for this aim
5. micronutrient deficiency, which is common in end-stage liver disease has adverse effects on the brain and may either directly cause encephalopathy per se, or interact with mechanisms leading to hepatic encephalopathy.

So this study is saying, do not restrict protein, but do take BCAAs and definitely take probiotics and also supplements that you are deficient in - I have already posted some of those above.

I hope that helps,

Mike

[mhudnall]

I should have said that phoshpatidylcholine's PEMT biosynthetic pathway depends on three successive methylations of ethanolamine by SAMe

[mhudnall]

Schizandra is well known to normalize liver enzymes

[mhudnall]

SAMe is integral to all of the specific biosynthetic pathways that Hepatitis C infection alters metabolically. That is no surprise because SAMe is involved in the biosynthetic pathways of over 40 compounds made by our body. The reason for this is because SAMe is the most ready donor for methyl groups among all methyl donors. It is also involved in the transsulfuration pathway, which is important for our physiological antioxidant systems. Glutathione is SMAe dependent through the homocysteine cycle, phosphatidylcholine's PEMT biosynthetic pathway relies on three successive methylations of ethanolamine, a precursor lipid for PC synthesis. HCV also alter the methothioadenosine pathway which is totally SAMe dependent.

Lieber did a famous study in which he showed that supplementation of phosphatidylcholine relieves oxidative stress, because by supplementing the PC end product you save SAMe from flowing into the PC biosynthetic pathway and it goes into the Glutathione biosynthetic pathway instead, thereby improving oxidative stress status.

[zarmar]

Thanks for more discussion on nutrition.  

I was encouraged by my hepatologist several months ago to consider SAMe, S-adenosylmethionine, a synthetic form of a compound formed in the body from the essential amino acid methionine and adenosine triphosphate (ATP), the energy-producing compound found in all cells in the body  Anyone using this with good results?

As we know, dietary supplements do not get much medicine-application study, but from what there is on SAMe, the Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence as Likely Effective for decreased bile flow from the liver to the gallbladder.  It is prescribed in Europe for liver function, depression, and arthritis benefit.

There is a research article published in 2013 in Phytotherapy Research about schisandra and sesamin (SCH) on ALT and AST levels.  Link is below.  

From Sloan Kettering's website:

"Very few human trials have been performed with this supplement (SCH). Two small clinical trials suggest improvements in subjects with fatty liver disease using a mixture of schisandra fruit extract and sesamin, a lignan marketed as a fat-reduction supplement (21), and possible benefit for those with chronic hepatitis C virus when used in combination with other oral antioxidants (22). Another small trial of a proprietary herbal combination that included schisandra suggests improved performance of cognitive tasks (23). Schisandra was also found to reduce tacrolimus-associated side-effects of diarrhea and agitation and to improve liver function in liver transplant patients (24). Additional research is necessary to determine actual efficacy attributable to schisandra and to uncover possible interactions or side effects associated with this supplement,"

More info online and at:
http://www.nlm.nih.gov/medlineplus/druginfo/natural/786.html
http://onlinelibrary.wiley.com/doi/10.1002/ptr.4702/full
http://www.mskcc.org/cancer-care/herb/schisandra

As always, supplements should be reviewed in advance with your care team.  Every person has individual body chemistry and health history, so .  If there is newer study data you come across, it will help to send link to your team so you can all be on same page when discussing.

[mhudnall]

Good luck, and I'm sure that was not enough to affect anything.

Treatment is really an artificial metabolic scenario, and normal rules do not apply. In other words, stuff that promotes health often works in opposition to the effects of the drugs, where health is not the goal, eradication of the virus is.

[Pamelajean1]

Oops....I took B12, D3 and magnesium during tx. But not megadoses. Pharmacist approved it....actually approved the blend I'm taking now with the Alpha Lipoic Acid but I waited until EOT. Appears that was a good decision. So far I'm UD. 12 week EOT is 9/5...say a prayer for SVR.

Thanks again for the heads up!

[Pamelajean1]

I took B12 during tx too....and still do. I think the methylcobalamin B12 is better absorbed than the cyanocobalamin B. Mike could probably explain it better. I take mine (along with D and magnesium) for leg cramps and when I switched to cyanocobalamin started having cramps again....went back to the methylcobalamin and they stopped. Everyone is different but that's what works for me.

[mhudnall]

Yeah, he was probably trying to up your red blood cell production, probably because you were in danger of anemia, but that's not enough to really hurt tx effects.

[hepcandme]

hmmm
I took B12 during treatment per doc's instructions. 500 mcg
That's OK, right?

[mhudnall]

Thanks Pamelajean1, good to from you!

Rule of thumb is no supplements while on treatment.

But HCV patients and cirrhotics run short on vitamin D and magnesium. Those are from nutrient deprivation studies on HCV patients and cirrhotics.

Vitamin D is deficient in most people but its worse in HCV patients.

With all the supplements never take megadoses, but take moderate doses and THE KEY IS: split the doses into three and take them morning, afternoon and night to maximize nutrient retention times in the tissues. That promotes homeostasis in HCV-altered systems for optimized lengths of time.

[Pamelajean1]

Hiya Mike! Another great post....
I was confused when first dx with HCV about protein but when I met with a nutritionalist she talked about how important it was. With my BMI, she determined I should be getting 7oz per day which made me happy...I like my eggs, meat, etc.
Big believer in probiotics....even before HCV....'normal' people benefit from it too IMO.
Just started taking a blend of B's, D and R-Alpha Lipoic Acid. Clinical studies have shown it's good for neuropathy. Glad to see it could be helpful otherwise as well.
What's your take on magnesium? Dr. Dennis Goodman is promoting it in his book 'Magnificent Magnesium'...talks about D being deficient in most people and he thinks same of magnesium. That it can help heart, BP, and a lot of symptoms from HCV....fatigue, cramping, insomnia, depression...affects a lot of bodily functions.
I've never been a supplement person but I don't like a lot of medications I'm starting to realize that if I can help my body without synthetics I'd be better for it. I wish the system would train our docs with a bit more info than they do now!
Always good to 'see' ya! Be well!

[mhudnall]

I think adding BCAAs to your amino acid mix would just result in upgrading the percentage of BCAAs in the diet, - nothing wrong with it, the other amino acids are fine, but it is the BCAAs that really bring the positive effects.

The probiotics are really important as well. Bad gut flora and disease form a continual feedback loop, disease will cause negative changes to gut flora and bad gut flora works in extremely negative ways to exacerbate disease. Could the virus be manipulating the nutrient content through bad gut flora to benefit its lifecycle over ours? You bet it can and does.

[GP7852]

I have been taking free form aminos for a long time.Can I take the bcaa along with my free forms or would that be too much?