Fatty meal for better Riba absorption vs. healthy meal for liver?

Recently a nurse from Roche told me to eat a high fat content meal when I take my Ribaviron because it absorbs better.  On the other hand, I went to a liver seminar last week and asked a hepatologist who was giving a lecture on "fatty liver"; he said what's most important is to take Ribaviron with CALORIES.  I know for our livers low fat is better, so should I pay attention to what the Roche nurse said about high fat meals when I take my Ribaviron?  What do you guys think?  Can you add anything to what I've heard?  What do you do?  Thanks, Aiuta

[jmjm530]

My understanding is the same as that of your nurse. Take your riba was a reasonably high fat meal. The riba will not only be absorbed better, but there should be less chance of stomach upset. The doctor's point, however, is not necessarily inconsistent, as larger meals tend to have more fat, as opposed to taking the riba with a snack. When treatment is over, by all means go back to a lower fat diet if that's what's called for.

Consistent with this, and with the blessing of both my NP and doctor, instead of taking my riba 12 hours apart, I took it with breakfast and dinner -- my only two meals of the day. Bkfast was usually between 10-11 AM and dinner between 3-6 PM.

Lastly, for maxium absorption, don't take antacids within 2 hours of the ribavirin. PPI's like Nexium, Prilosec and Aciphex are OK to take with the riba, as are OTC H-2 pumps like Zantac and Pepcid AC. Pepsid Complete, on the other hand, contains an antacid, so it should also be spaced away from the riba. Same with Gaviscon -- space it away from the riba.

Also, if you want to be somewhat riba neurotic as I unabashedly was , don't take the riba with flax, metamucil, bran or other fiber supplementation, as in theory it will also impede riba absorption.

-- Jim

[SoCal Lady]

"Fatty" doesn't have to mean unhealthy.  For example, nuts have a high fat content, so I sprinkle some chopped walnuts on my morning oatmeal, or spread peanut butter on toast, or have an egg with a piece of buttered toast.  Another favorite breakfast is yogurt mixed with some fruit and nuts.

Almost anything you might have for dinner has enough fat to enhance the absorption of the riba.  Take the pills in the middle of breakfast and dinner and you'll be fine, if you're eating the kind of food most Americans eat.  Don't deliberately seek out high fat foods, just take the pills when you're taking in the most fat of the day---hopefully, that's at mealtimes...

This has worked for me (or something has)---I was UND at 4 weeks.  Well, I'm a genotype 2, so that has been to my benefit too.

Good luck!

[sfbaygirl]

Will a fiber cereal do this? I was eating this at the beginning of tx for breakfast w/ my Riba. Now I take Ensure with the Riba, b/c I just can't eat in the morning anymore. Do you think this is enough fat? It is low fat and has 250 calories. I tried the fatty Ensure (to put on weight) and it made me sick to my stomach, so I switched back. Sometimes, I just drink milk or eat cheese with the Riba. I eat 2 meals a day, but sometimes I don't eat until after 3 PM and have only one meal. It isn't large either. somedays, I can eat and eat and eat, but those are few and far between.

At first I could hardly get anything down but ice cream, so I would eat that with the Riba, thinking of the fat.

I know many drugs they say take with food or milk, I assume it is because of the absorption of the drug. It seems that this would be calories, right?

How's the skin problems? Getting better?

[sfbaygirl]

To add to my one meal a day statement....I do eat small things during the day. An apple and cheese, an avocado, milk, so I am not starving myself all day. I just can't eat much at a time most days. Then I have to REALLY want it, or I can't even get my mouth open to shove it down. BTW I didn't take that Ensure (to gain weight) to gain weight, I do not need to gain weight! It seems like I do 'snack' most days, since I eat so little even at meals.

[jmjm530]

You just got to do the best you can. The whole food thing can be very difficult on treatment, I know for me it was torture at time between the GERD (reflux), nausea, and taste alteration.

Other than the general idea of taking riba with a higher fat meal and without antacids, I wouldn't want to venture any guesses what will work and what wouldn't.

I couldn't find it, however the "high fat" meal used in the absorption study is somewhere on the net. From memory -- and only from that -- I think the meal was around 800-900 calories with close to 50$ coming from fat.

Given that there are 9 calories per fat gram, that's what -- no calculator around -- about 50 grams of fat ? If so, and maybe some nutritional oriented person will check my math, it doesn't sound like your low-fat Ensure meets that criteria, but then I doubt many of us have 50 grams of fat per meal although I may have come close with my treatment breakfast of ham and cheese omelet with homefries and double-buttered toast :)

In the end, you just do the best you can. Here's some technical reading on fat and riba absorption.

http://tinyurl.com/eljeb
http://www.rxlist.com/cgi/generic4/copegus_cp.htm

[sfbaygirl]

Just the thought of almonds, nope I couldn't do it. I am also nut shy b/c they can cause me migraines. Now maybe some macadamea nutz... I always regret it when I get a migraine though. Besides I don't think I could get them down. I think I could literally starve myself, with my lack of appetite, if it weren't for my crazy cravings for certain foods during tx.

[NYgirl]

I take my pills in the morning with breakfast (and I am not much of an eater so I drink a yogurt smoothie at least - or a half of an english muffin with peanut butter) at 7am and then I take them with my dinner at about 7pm.


In addition to taking them with FAT (which is so important) and it also helps with stomach troubles if you take them with the meal.

Plus - taking them at meal time it makes it easier to remember to take them.

[merlino]

Hi Rocker, I will be joining the tx train by end of week(waiting for meds). I have stopped taking every vitamin,herb and so on in preparing for tx. I had a few questions I hope you can help with. Is taking a multi vitamin with no iron enough? The beet powder-what do you mix it with? I have already cut my gym time down from 3+ to once or twice a week having read that once tx is started best to slow it down. My diet right now is so bad I won't even tell you. I have been trying to gain weight so...... I know this has to stop but I really need to keep the weight on. Tried ensure, no way i could get it down.Basically I went from a exercise eat right take vitamin person to stressed out, tired look like $$$$ grouchy  and haven't even started yet.

[merlino]

Hey Deb, I have been thinking about you all weekend. How did everything go with getting your meds? Any luck with Dr. J calling the insurance people? I am still waiting for mine to be delivered. My last visit with the liver dr. b4 tx is tomorrow. I am planning to start Friday night. This is going to be a very long week.

[Morgaina]

Good to hear your skin problems are calming down, they were really grieving you for a while there. Cozy shack was my one thing I could always eat, still have a slight addiction, only now I can eat the whole darn container instead of a few bites!!

[cuteus]

the study mentioned on the bioavailability of Riba with food stated that an increase of availability was achieved in the group ingesting the high fat meal and compared to the FASTING group, not the standard group.  That is why the suggestion says to take the med with food and not with high fat food. Any meal with at least 30% of calories derived from fat should be enough, but if you become anemic with a low fat meal, that means that the small amount of fat you are taking is enough for YOU.
take care

[NYgirl]

Hey!  Friday is the day huh?  I bet you make out just great = when you see that it is really just us whiners in here...and the rest of the population that is treating is out there just living life - you'll be like ah and I thought they were so smart, they are just a bunch of cry babies...this isn't bad!   :)

;)

No word from Dr. J's office. I have to call again.  I have talked to Committment to Care = wow.  I have to tell you it's so bizarre that they are dying to give away the meds for FREE and the insurance company won't let me even have them!  How phenomenal it really is.  I'm just waiting for the paperwork. They even said "wow I wish you had gotten us sooner, we would have sent a prescription for your doctor to fill out to give you a months worth of meds while the paperwork is going through" can you believe that!!!!!

It's just shocking to me. Thank God for them.

I have decided I'm going to get even with the insurance company big time.  I am going to go for every single doctor visit that I can find that is covered by insurance. Mammogram...pap test...even a freaking brain scan if I can get it approved LOL!  Since I have PPO insurance I can go to whatever specialist I want without prior approvals so...I think a visit to the dermatologist, gynecologist, endocronologist, gastoenterologist...are all in order about now!

;)

[merlino]

Thats unbelievable. What really bother me is a persons life is on the line and they don't make ANY exceptions! They really do play God! I would do the same thing you are! I truly hope it all goes well. The commitment to care people sound wonderful! I probably will drive everyone here crazy on Friday!

[Kalio1]

I am fully insured too but Commitment to Care provides my drugs. I was just too sick to try to argue with the ins. company in the beginning and CTC was SO helpful and easy. You do have to call and order your meds a WEEK AHEAD and be careful if there is a holiday as that will delay it. get in the habit of ordering it each month and you will have no problems as long as someone is there to receive the package when it is delivered.
Good plan to go with CTC and then also keep on that ins. company and squeeze every dime you can from them.
Hey! You should be gtting your mammos and paps already! Schedule them tout suite my dear. One out of every 5 women has or has had breast cancer.I know mammos aren't perfect but they do catch a lot of cancers early.
Your Mom is such a sweetheart, I was so glad she was there for you in that stressful time. I hope those ins. jerks eventually pay you/her back too.

[jmjm530]

Fortunately, my memory was not too far off. The "high-fat" meal as defined by the food absorption study was 841 Kcal with 53.8 grams from fat, 31.6 grams from protein, and 57.4 grams from carbs. If my  computations are correct, the meal used in the study was 57% fat, based on calories. Again, no clinical relevance is stated.

Source: http://www.drugs.com/PDR/Rebetol_Capsules.html

[aiuta]

Thanks Cuteus.  Good to hear from you :-)  Aiuta

[NYgirl]

It was because of your continued postings about C2C that I thought to check it out.  One of the many many life saving things you have posted in here in the past year I've been a member.

You know how much you have helped me during my course of treatment, I hope.  

I was SHOCKED at how NICE they were when I called. And how FAST it went (how much do you make...yes you qualify) I don't make THAT little (I thought - even though I complain constantly) and was holding my breath.

Hopefully the papers will come today - as well as the prescription forms for the month of meds. That will mean I have seven weeks still to get it done...hopefully one of my doctors will be fast enough to get it done!

[sfbaygirl]

Geez, if I need 800-900 calories with 50% fat, I need to go back to my big bowl of ice cream in the mornings. Ensure doesn't cut it. I thought I was being good. Thanks for the links, I will check them out.

I can only get down what I can get down, otherwise other issues would come up! LOL

Yep, the GERD is one of those problems with eating, especially when the nausea hits. As you say, I can only do my best. And I am at least getting something down with those Riba's. I don't know how you got so much fat down with all your stomach issues!

[jmjm530]

Rock,

I think your 30 grams of almonds contain around 15 grams of fat. You can double check with some food/fat tables.

SF,

I'm not suggesting anyone take 50 grams of fat with riba, just trying to estimate what the study used. I did try ice cream at one point to gain weight but it just made me nauceous. Same with Sarah Leigh's frozen cheesecake, another very high fat/caloric food.  

Without going into details, my whole food thing during treatment was totally screwed up and many of my favorite foods make me nauceous just thinking about them.

Lost 30 pounds I didn't have to lose and when I did try smaller, more frequent meals, the reflux and meal trauma was actually worse and I lost too much weight. Everyone is different and has to find their own way with food. Now, seven months post treatment, my appetite is totally back to normal and I probably should lose around seven pounds :)

My skin and rosacea in particular is getting much better. Hopefully, by next summer I'll be able to handle a normal amount of sun and outdoor activity. Thanks for asking.

-- Jim

[jmjm530]

Don't know if this will help with the food, but with me a lot of it was mental.

My taste sensations were so screwed up that I had to dig very deep to find something my mind would tolerate. As f*cked up as it may sound, literally spent hours making lists of different foods and meals I liked since I was a kid. In fact, it turned out that most of the foods I could eat was stuff I ate as young child, as opposed to tastes acquired as an adult.

Also googled "high fat foods" and made more lists. Confided in an "ex" and she suggested Cozy Shack Puddings which worked out. Even sent my brother to the supermarket to scope out higher fat convenience foods. At one point when I was afraid I'd have to stop treating due to weight loss, I kept a food log with calorie goals for each meal. If I ran short, I'd try and stuff another Cozy Shack, Ensure, or someting down the throat. Have you tried "Prosure"? I think it has more calories than Ensure plus contains Omega 3's. The Vanilla wasn't too terrible.

Never had a problem with food before or since treatment. Peg and riba can really do a number on you :)

-- Jim

[aiuta]

Thanks you guys.  This was VERY helpful feedback and information as well as links.  I would like to repeat SFbaygirl's question for/to Jim though: "Is fiber cereal in the morning (with the Riba) 'bad'"?  Would YOU eat fiber cereal in the am with your Riba?  -Aiuta

[jmjm530]

Other than what was mentioned in the links above, I don't think any more detailed research has been done on riba and fat absorption. In fact, all they used to tell study participants was to "take riba with food".

I guess where I'm going is that anything beyond that can get quite subjective and speculative. But for what it's worth, I did occasionally have All Bran with whole milk, eggs and buttered toast for breakfast. I also bought some Uncle Sam Cereal at the Health Food store but stopped using it when I read something about Flax impeding the absorption of some medications.  

Look, you obviously don't want to make yourself sick eating more fat than you can tolerate, but on the other hand you probably don't want to take your riba with only an apple. In my case, other considerations for my meals were my weight loss and taste alteration problems.

In the end, we all have to find a way that works. My way ended up being two high fat meals per day but that may not work for you.

-- Jim

[aiuta]

You guys BOTH "rock".  Thanks for the very helpful information and thanks for making me laugh while reading it.  Aiuta

[Kalio1]

I'm so happy you called them! they are nice and I too was suprised I qualified. I didn't think I had a snowballs chance.
Hopefully that will take the pressure off for the remainder of your tx. Maybe even beyond should you need it, my first approval was for 48 even though the doc only ordered 24.

[GoofyDad]

FWIW, I tried to keep ripe avacados around. If I thought my meal was fat deprived, I ate an avacado and a tablespoon of cod liver oil (the Nordic Naturals orange flavor ain't bad at all).

[jmjm530]

Goofy: FWIW, I tried to keep ripe avacados around.
------------------------------------------------------
Tried that too, but my girlfriend at the time objected.

[jmjm530]

My read of the study suggests that the bioavailability of ribavirin increased when eaten with a high fat meal compared to BOTH the "fasting" group and the "standard meal" group. Note that it says "a standard meal did no affect ribavirin bioavailability" while it states a high-fat meal does.*

As to the instructions "take with food", I believe the source of that is to be consistent with the original trial data which used those identical instructions, and not because of the bioavailability data, as I don't believe was available at the time.

I do agree that anemia is an imprecise but useful marker as to how things are going. The rate of viral load drop is even better and that's why more frequent viral load testing seems to be becoming more popular.

Going back to the whole high-fat thing for those interested. Because a "standard" meal appears not to affect riba absorption, one may indeed have to have as much as 50 grams of fat per meal, if my recollection of the defintion of "high-fat meal" is correct. (The actual calorie count and fat percentage is out there on the net somewhere for those who want to spend more time on this.)

Still, I know of no doctor recommending anyone take this much fat (50 grams) per meal, and I'm certainly not going to recommend it. In fact, my guess is that many doctors who advise to take riba with food, or with fat are doing so because of gastric issues, not absorption issues which state no proven clinical relevance which btw does not at all mean they don't have a clincical  relevance, just that the clinical implications haven't been studied.  

All we can do is look at the articles, talk to our doctors and come to our own conclusions and strategies. In my case, I did make an attempt to eat that much fat, especially early-on in treatment, but that was my way, not necessarily anyone else's.

-- Jim

* Brittish Journal... p. 2

[FlGuy]

Did the rx for the tx meds make it through the authorization and certification process? Just wating for delivery?