Proteins and Liver Disease

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1Shelly1
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Date Joined Oct 2007
Total Posts : 502
   Posted 2/29/2008 9:27 AM (GMT -6)   
Hi everyone, there is so much confusion about liver disease and protein that I wanted to help everyone understand how it all works. It's very complicated I know. If you can just imagine that the body as a whole is like a computer-full of data all coming from various places. Overall it functions very well when the data is entered correctly. However; when there is an input data error or problem the computer no longer functions the way it was supposed to. So, like the computer your body works the same way. This little exerpt is only a small fraction of the input that makes our bodies work properly and again it is just a synopsis (a quick one at that) of what protein is, why we need it, and what happens if there is a glitch in the body or input data. Finally, how the body reacts. Liver disease is the input data that is flawed or in error. So here goes.............

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.

 SHELLY


CaryF
Regular Member


Date Joined Nov 2007
Total Posts : 320
   Posted 2/29/2008 12:32 PM (GMT -6)   
Hi Shelly,

Again, thanks for the excellent info. Minimal protein intake is of great concern to me & I monitor it daily.

Would you be willing to take your best geuss on how much protein a person with Hep C (or any liver disease) should intake daily? I realize this can be different for everyone - but as I am consciously attempting to reduce my protein input to only the level I "need", what would you suggest that migt be?

Best, Cary

1Shelly1
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Date Joined Oct 2007
Total Posts : 502
   Posted 2/29/2008 1:09 PM (GMT -6)   

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

CaryF
Regular Member


Date Joined Nov 2007
Total Posts : 320
   Posted 2/29/2008 3:15 PM (GMT -6)   
Thanks Shelly,

Since becoming (OK, not strictly) vegetarian & dramatically reducing my protein intake I've not suffered a single bout of encephalopathy. I also feel clearer mentally in general and have more energy. So, I've personally realized the importance & benefit of reducing protein to help my liver manage my Hep C. I'm going to go with 10% max protein of daily caloric intake & run it by my Hepatologist at next appt. This in reality is very little protein, some days I can get it from a handfull of nuts.

Best, Cary

1Shelly1
Veteran Member


Date Joined Oct 2007
Total Posts : 502
   Posted 2/29/2008 7:37 PM (GMT -6)   
Cary, It sounds like you are really watching what and how you eat. Diet is so important to remain well and healthy. Good for you........as far as the amount of protein you chose to eat again it sounds like you are doing well. Good luck.
Hugs
Shelly

exhaused
Regular Member


Date Joined Nov 2007
Total Posts : 445
   Posted 2/29/2008 7:49 PM (GMT -6)   

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.

Thanks again

JoAnn


1Shelly1
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Date Joined Oct 2007
Total Posts : 502
   Posted 2/29/2008 8:11 PM (GMT -6)   

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.

 Hugs, Shelly


exhaused
Regular Member


Date Joined Nov 2007
Total Posts : 445
   Posted 2/29/2008 8:20 PM (GMT -6)   

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


1Shelly1
Veteran Member


Date Joined Oct 2007
Total Posts : 502
   Posted 2/29/2008 8:34 PM (GMT -6)   

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.

 Hugs Shelly


okielady
Regular Member


Date Joined Sep 2007
Total Posts : 77
   Posted 2/16/2009 10:27 PM (GMT -6)   
about the protein, when Jerry started getting worse, he didn't want meat, but he wanted pinto beans, which was his protein.  I've heard a persons body will let you know what it needs. (If you listen to it) It did in his case.
 
Joann, I saw several people at the transplant center that had had their transplants and looked so healthy.  Jerry even built some muscle back before the cancer got going good.  Keep up the faith and I'm sure your Jerry will do great.  I'll never forget this older farmer that was there one of the last times we were there.  He had his transplant several years ago and I promise you he looked good and healthy. He was a true inspiration.
Helen

luckydog53
New Member


Date Joined Feb 2009
Total Posts : 8
   Posted 2/17/2009 12:19 AM (GMT -6)   
In a broad overview of diet, I try to eat roughly a 50/50 combination of the two food groups: 1. fats and proteins, and 2. carbohydrates in every meal. Too many carbs in a meal leads to blood sugar problems associated with hep c. Too much bad fat is bad in a number of ways. Sometimes for me protein and fats will kill my sugar cravings. A brilliant athletic trainer that I follow (Paul Chek) believes that the proper combination of the two food groups maximizes the metabolism to burn the fuel more completely and efficiently.

But probably the most important thing for me is not to eat to excess. My goal is too eat only as much as my body will metabolise without going into storage mode. That means small meals of the proper proportions and fairly often through the day. I believe that any excess will benefit the virus instead of me.

When I eat this way I feel great. But when I eat poorly it can really get to me. Being on a clean diet makes your body a lot more sensitive, and that isn't necessarily always pleasant when you indulge.

In the middle of a crisis it is hard to concentrate on food, but it is an important thing to focus on, because bad or deficient nutrition can make an acute situation worse.

hep93
Elite Member


Date Joined Jul 2005
Total Posts : 12014
   Posted 2/17/2009 4:07 PM (GMT -6)   
I agree with your general view, luckydog.  I am much more in tune with my body and what I put into it these days.  However, with some of the very sick patients, it seems to be a challenge to get any nutrition into them.  They simply have no appetite.  Sometimes it seems best, in those cases, to get whatever they will eat into them.

hep93
Forum moderator - Hepatitis
 
"But that was yesterday, and I was a different person then."
Lewis Carroll, Alice in Wonderland


luckydog53
New Member


Date Joined Feb 2009
Total Posts : 8
   Posted 2/17/2009 4:35 PM (GMT -6)   
Yes, I agree. Deficient nutrition is worse than too much, even for a non-acute patient. I know many (most) cancer deaths are from malnutrition because the patients can't tolerate food in the end stage. I imagine Hepatitis patients are similar in the end stages. It is heart-wrenching.

Luckydog

hep93
Elite Member


Date Joined Jul 2005
Total Posts : 12014
   Posted 2/17/2009 4:59 PM (GMT -6)   
Actually, in the end stage of any disease, when the patient is nearing death, he loses appetite.  The body is starting to shut down.

hep93
Forum moderator - Hepatitis
 
"But that was yesterday, and I was a different person then."
Lewis Carroll, Alice in Wonderland


1Shelly1
Veteran Member


Date Joined Oct 2007
Total Posts : 502
   Posted 2/17/2009 7:00 PM (GMT -6)   
You are correct Hep93, in the end stages the patient should eat whatever they want to eat. That is my personal opinion. To me it doesn't matter just so that they get some nutrition because they have little appetite. Megace is a medication that is given to increase appetite and works quite well. The goal being to get the patient to get enough nutrition to prevent starvation. Dr's may disagree but I feel anything is better than nothing. If the patient has just a short time left I let them eat whatever they want, not just for nutritional value but what little pleasure it may bring them.
 Shelly
 

“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."

 


Pink Grandma
Veteran Member


Date Joined Nov 2006
Total Posts : 2445
   Posted 5/4/2009 1:37 AM (GMT -6)   
Bump
Pink Grandma
Forum moderator-Hepatitis

When the going gets tough....the tough get going! Don't always know where I going but I get there anyways.


hep93
Elite Member


Date Joined Jul 2005
Total Posts : 12014
   Posted 12/20/2012 4:38 PM (GMT -6)   
You picked a very old post to reply to. Our rules do not allow "advertising." Therefore your post has been deleted.
hep93
Forum moderator - Hepatitis


"But that was yesterday, and I was a different person then."

Lewis Carroll, Alice in Wonderland

Liver transplant recipient, Oct. 27, 2011, at Mayo Hospital, Jacksonville, FL

JuniorDavis
New Member


Date Joined Mar 2013
Total Posts : 1
   Posted 3/12/2013 5:23 PM (GMT -6)   
Shelly any chance you would know why I would get bad pain under my scalp (Almost like bruising)?

I noticed that the pain comes with a decent amount of protein (30-40g).

If I eat scallops the next day the pain is really bad.


However, I am simply trying to understand if this is an ammonia issue. Because when I take L-Ornithine the pain is gone.

But if I miss a dose it comes back.

Depending on what I eat.

My diet is hard as it is. Gluten Free, Non GMO, Low fat and Protein (Hep C).

Thanks

hep93
Elite Member


Date Joined Jul 2005
Total Posts : 12014
   Posted 3/12/2013 6:42 PM (GMT -6)   
Junior, you responded to a very old thread. I haven't seen Shelley around here for quite awhile. I can tell you that I've never known anyone to post about this symptom before.

I suggest that you start your own thread (click on New Topic instead of Reply), and you can explain your symptoms. You will get more replies that way.

Hugs,
Connie
hep93
Forum moderator - Hepatitis


"But that was yesterday, and I was a different person then."

Lewis Carroll, Alice in Wonderland

Liver transplant recipient, Oct. 27, 2011, at Mayo Hospital, Jacksonville, FL
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