Protein is an essential part of our diet and helps the body, grow tissue, regulate hormones, control metabolism, repair muscle, and defend against illness. The human body has to have protein to survive. Proteins are made from lots of amino acids that cluster together and convert to protein. Amino acids are made of carbon, nitrogen, hydrogen, and oxygen atoms, and are the building blocks of the human body These different proteins are dispersed to perform different functions in the body. Since the body can’t store protein it has to be replenished daily. There are several natural proteins in our blood but others have to come from dietary sources.
The amino acids that are not used up as proteins (because we can’t store it) are converted into urea. Urea is broken down protein made in the liver and sent to the kidneys to be excreted as urine (urea is toxic and must be excreted as waste). The Dr can measure urea by doing a blood test called a BUN. It stands for Blood Urea Nitrogen. Remember that the amino acids are made of many things including nitrogen which is measurable. It is one of the kidney function tests Dr’s do. When the body can’t remove the urea from the blood the BUN level is high. Liver Disease is one of the causes for a low BUN levels as well as the cause of elevated BUN levels. When urea isn’t excreted it builds up to toxic levels causing elevated ammonia levels. The elevated ammonia levels then causes confusion etc. (THAT’S A WHOLE OTHER STORY)
This is all like a vicious cycle when patients have liver disease. One thing leads to another. Too much protein and the sick liver can’t process it properly and the urea builds up which causes the ammonia levels to rise. As a result the kidneys can’t spill either one so now the kidneys are affected too.
Too little protein and the body hunts for it. It‘s like robbing Peter to pay Paul. Since we have to have protein to survive the body reacts when we don’t have enough. It actually will take protein from other places. Instead of the protein going to their destinations for use in the body the brain steals it from the muscles, tendons, bones and other organs to keep it in the bloodstream. Thus; there is muscle wasting, muscle cramps, profound fatigue, and many other undesirable effects.
It is a constant battle to maintain adequate levels of protein and yet not over or under do them.
Boy Cary, that is a tough one. First there are normal’s for people of good health. As far as I know it is based on body weight. But another method of calculation is 10-15% of caloric intake should be dietary protein. When liver disease is involved it becomes really difficult to know. There are various types of liver disease and various stages so it is almost impossible for me to answer your question. Since encephalopathy occurs so frequently with liver disease the protein influences the degree or severity of the encephalopathy. That would be a question you would have to ask your heptologist. I would be lying if I said I knew the answer. It is too variable. I’m sorry I just can’t even guess. The standards for normal change quite a bit so evaluating protein in a person with an abnormal liver is just too individualized.
Shelly We just returned with an appt at Vanderbilt with our hepatologist. He told us he has taken a big interest in nutrition and speaks all over the world about it. He told us many Dr. just don't want to mess with it and he's not sure why. Since Jerry's muscle mass is completely gone he has told us to get as much protein down him as we possibly can. Starting with dairy. I make him smoothies using soy protein and in the beginning I used Whey protein. I quit using the Whey protein because the Dr.'s here were telling me to not use animal base protein. The hepatologist told me not to listen to that. He wants Jerry to have as much protein as possible. He said very few hepatologists even do blood ammonia levels. They go strickly by the way the patient reacts. I have learned that. He told us if his ammonia level appears to be going up to just give him more lactalose! I have heard so many conflicting stories it makes my head spin. The first few episodes Jerry had with high ammonia were really scarey but now that I understand it more I'm going with what he said for now to try and help Jerry build up some muscle. We also got a toning tube to see if that helps. I sure hope so if not I guess we will have to try something else. Thanks for the lesson on protein. It is so very complicated to me but I'm trying to understand it. I think my biggest problem is trying to remember who told me what. I have taken your advise and started a journal. That is a big help. Keep the advise coming you are so good at it. I also feel you are very compasionate. And god knows we all need that!! I have had to deal with so many different personalities its hard!!! I realize that is what makes the world go around but these days I don't feel very safe having to face death every day. The compassion really helps! I think your mother is watching and must be so very proud of you.
JoAnn, thank you for the comment about my mom. It has been so hard losing her. As far as the protein issue as I said earlier it is really complicated but at some level we can all have a basic understanding of what, why and how they work. The muscle wasting is so unfortuante and it seems so unfair doesn't it? We went thru it all with my mom so I know how disheartening it is. I still propose that all end stage liver patients should be on appetite stimulants. I have argued for the wider use for a long time. If the patient is not eating it stands to reason they will have a starvation condition, If they are eating but not enough to promote healing then again we have the decreased protein issue with muscle wasting. Why not just Rx it automatically? I'll never know (however I do have my own opinions on that which I will not share with others). I would ask the Dr for it immediately. Within a few days of taking it you will see an increase in his appetite. He can then get some strength built back up at least. I'm rattling I know. I'll shut up on that for now.
Shelly Thanks for the info. I will ask next time we see him. Jerry is eating but not a lot. His favorite things are not high in protein. Like fresh fruit and Veggies. All the things that were pounded in our heads that were good for you. Now he needs more. I think you have a good idea. It would be nice if there was a protein pill!!! Also I wanted to ask do you get the muscle mass back after a transplant? I should know the answer because I have a brother that is a quadraplegic but I guess I have never really thought about it until now. No hurry I was just curious.
JoAnn, the question you asked is multi faceted. Muscle mass can be rebuilt but it is difficult if the patient doesn't have energy. When he is eating moe and regains some strength it is possible that he can do some minimal leg strengthing exercises. Then possibly short walks, and on and on. It is frustrating, painful, and slow to see results. The outcome depends on many factors including his desire.First lets get him eating better.
“Life is not the way it's supposed to be. It's the way it is. The way you cope with it is what makes the difference."