Aa
Riba and fiber question...
I start SOC on Thursday and saw in a thread today that fiber may inhibit the absorbsion of riba. I'm on the Atkins style diet and eat alot of fiber. Does the fiber matter when the pills are taken or at all times? Anything else I should know about riba?
"You really want to take the riba with fat - it needs the fat to bind to or you will just lose it out of your system. "
That's not true. Multiple-dose ribavirin half-life is 298 hours.
Every time I hear you guys tell somebody else to take their Riba with a high-fat meal, I tell myself, "Stay out of it. Disagreeing will do nothing for your popularity"...LOL. But it bothers me because I've been to many conferences and lectures and I don't remember being told that the Riba should be taken with a high-fat MEAL. Taking it with food yes, but not with 54 grams of fat. If I told people to do that, I would probably go to hell....LOL
First of all, let's see what the drug company that did the study means by "a high-fat meal"..... ( 53.8 grams of FAT, 31.6 grams of PROTEIN, and 57.4 grams of CARBOHYDRATE. A total of 841 calories per meal).
53.8 grams FAT = 482 calories. If you have 2 high fat meals a day, that would give you a total of 1682 calories.....964 calories from fat. Over 50% of the total calories would come from fat. Considering that only 30% of a person's total calories each day should come from fat, that would be a very unhealthy diet.
If you're a diabetic, you're allowed a total of 1800 calories a day. So that means that after eating your two high fat meals, you'll have 118 calories left for your third meal and two snacks....which may cause your blood sugar to be out of control.
What are you guys going to eat to make your meal "high fat"? Did you say TWO tablespoons of peanut butter? Hmmm.....that's only 16 grams of fat.....so you'll have to eat at least 6 tablespoons. Or a Big Mac, fries and 2 tablespoons of peanut butter.....Twice a day!
What they're suggesting is ridiculous and unhealthy.
But let's continue......I did a little research on the effects of food on Riba bioavailability....
"Two studies have been carried out to assess the effect of food (ie, a high-fat breakfast) on the bioavailability of SINGLE oral doses of ribavirin. An initial study by ICN Pharmaceuticals, Inc. showed MINOR EFFECTS on bioavailability, but a 33% increase in Tmax (Time to Maximum Concentration)"
That means it took longer to reach the maximum Riba concentration after taking one dose!!! Or to make it more clear, a high-fat breakfast SLOWED THE ABSORPTION OF RIBAVIRIN BY 33%!!!!!!!
"A subsequent study by Schering-Plough demonstrated more substantial increases in bioavailability: food increased the AUC (Area Under the Curve) and Cmax (Maximum Concentration) by 70% compared to the FASTING population, and Tmax (Mean Time to Maximum Concentration) which is usually 1.5 hours was more than doubled."
Ribavirin is rapidly absorbed following oral administration. Mean Time to Maximum Concentration after taking a single oral dose is usually 1.5 hours. So that means that instead of taking 1.5 hours to reach the maximum Riba concentration, it took over 3 hours. In other words, a high-fat meal increased the maximum concentration of Riba by 70% compared to people who were FASTING but it took TWICE AS LONG to do it.
In other words, the second study also showed that a high-fat meal slowed the absorption of Riba!!!! Are you impressed by the 70% concentration? Why? It's the same thing that happens after taking multiple doses.
"Although both studies consistently showed that food slowed the absorption of ribavirin, the extent to which food affected ribavirin bioavailability differed widely between the studies."
That's right. One study showed that a high fat meal had no effect on bioavailability.
"It is also UNKNOWN whether any food effect might be altered by the type of meal consumed (eg, high versus low fat), IF A FOOD EFFECT WOULD STILL BE EVIDENT UPON MULTIPLE DOSING OF RIBAVIRIN, and, finally, what clinical implications the food effect might have. It should be noted that in the pivotal Schering-Plough clinical efficacy studies, ribavirin was administered without regard to food. Because of the uncertainty about the effects of food, it may be prudent for patients to TAKE RIBAVIRIN WITH FOOD."
Notice how it DOES NOT say HIGH FAT food.....just food.
"The fact that the multiple-dose ribavirin half-life (298 hours) is considerably longer than the single-dose half-life (79 hours) MEANS THAT IT IS NOT POSSIBLE TO PREDICT MULTIPLE-DOSE RIBAVIRIN PHARMACOKINETIC PARAMETERS BASED ON SINGLE-DOSE PARAMETERS. This has implications for interpretation of food effect pharmacokinetic data."
In other words, the data from the two high fat meal studies is great for those of you who are planning on taking ONLY ONE Ribavirin dose.....LOL
Think about it. If fat really increased the benefit from Riba, Schering would be selling "Ribavirin ice cream".
Sources:
http://www.medscape.com/viewarticle/416602_2
http://www.drugs.com/pro/ribavirin-capsules.html
That's not true. Multiple-dose ribavirin half-life is 298 hours.
Every time I hear you guys tell somebody else to take their Riba with a high-fat meal, I tell myself, "Stay out of it. Disagreeing will do nothing for your popularity"...LOL. But it bothers me because I've been to many conferences and lectures and I don't remember being told that the Riba should be taken with a high-fat MEAL. Taking it with food yes, but not with 54 grams of fat. If I told people to do that, I would probably go to hell....LOL
First of all, let's see what the drug company that did the study means by "a high-fat meal"..... ( 53.8 grams of FAT, 31.6 grams of PROTEIN, and 57.4 grams of CARBOHYDRATE. A total of 841 calories per meal).
53.8 grams FAT = 482 calories. If you have 2 high fat meals a day, that would give you a total of 1682 calories.....964 calories from fat. Over 50% of the total calories would come from fat. Considering that only 30% of a person's total calories each day should come from fat, that would be a very unhealthy diet.
If you're a diabetic, you're allowed a total of 1800 calories a day. So that means that after eating your two high fat meals, you'll have 118 calories left for your third meal and two snacks....which may cause your blood sugar to be out of control.
What are you guys going to eat to make your meal "high fat"? Did you say TWO tablespoons of peanut butter? Hmmm.....that's only 16 grams of fat.....so you'll have to eat at least 6 tablespoons. Or a Big Mac, fries and 2 tablespoons of peanut butter.....Twice a day!
What they're suggesting is ridiculous and unhealthy.
But let's continue......I did a little research on the effects of food on Riba bioavailability....
"Two studies have been carried out to assess the effect of food (ie, a high-fat breakfast) on the bioavailability of SINGLE oral doses of ribavirin. An initial study by ICN Pharmaceuticals, Inc. showed MINOR EFFECTS on bioavailability, but a 33% increase in Tmax (Time to Maximum Concentration)"
That means it took longer to reach the maximum Riba concentration after taking one dose!!! Or to make it more clear, a high-fat breakfast SLOWED THE ABSORPTION OF RIBAVIRIN BY 33%!!!!!!!
"A subsequent study by Schering-Plough demonstrated more substantial increases in bioavailability: food increased the AUC (Area Under the Curve) and Cmax (Maximum Concentration) by 70% compared to the FASTING population, and Tmax (Mean Time to Maximum Concentration) which is usually 1.5 hours was more than doubled."
Ribavirin is rapidly absorbed following oral administration. Mean Time to Maximum Concentration after taking a single oral dose is usually 1.5 hours. So that means that instead of taking 1.5 hours to reach the maximum Riba concentration, it took over 3 hours. In other words, a high-fat meal increased the maximum concentration of Riba by 70% compared to people who were FASTING but it took TWICE AS LONG to do it.
In other words, the second study also showed that a high-fat meal slowed the absorption of Riba!!!! Are you impressed by the 70% concentration? Why? It's the same thing that happens after taking multiple doses.
"Although both studies consistently showed that food slowed the absorption of ribavirin, the extent to which food affected ribavirin bioavailability differed widely between the studies."
That's right. One study showed that a high fat meal had no effect on bioavailability.
"It is also UNKNOWN whether any food effect might be altered by the type of meal consumed (eg, high versus low fat), IF A FOOD EFFECT WOULD STILL BE EVIDENT UPON MULTIPLE DOSING OF RIBAVIRIN, and, finally, what clinical implications the food effect might have. It should be noted that in the pivotal Schering-Plough clinical efficacy studies, ribavirin was administered without regard to food. Because of the uncertainty about the effects of food, it may be prudent for patients to TAKE RIBAVIRIN WITH FOOD."
Notice how it DOES NOT say HIGH FAT food.....just food.
"The fact that the multiple-dose ribavirin half-life (298 hours) is considerably longer than the single-dose half-life (79 hours) MEANS THAT IT IS NOT POSSIBLE TO PREDICT MULTIPLE-DOSE RIBAVIRIN PHARMACOKINETIC PARAMETERS BASED ON SINGLE-DOSE PARAMETERS. This has implications for interpretation of food effect pharmacokinetic data."
In other words, the data from the two high fat meal studies is great for those of you who are planning on taking ONLY ONE Ribavirin dose.....LOL
Think about it. If fat really increased the benefit from Riba, Schering would be selling "Ribavirin ice cream".
Sources:
http://www.medscape.com/viewarticle/416602_2
http://www.drugs.com/pro/ribavirin-capsules.html
It's fiber supplements like Metamuscil, bran, and flax that can be the problem and not fiber-rich foods unless it's something very fiber fortified like Uncle Sam's Cereal, for example. Also avoid antacids like tums, maalox, mylanta, Gaviscon, etc. within a few hours of the riba. PPI's like Nexium are OK and so are H-2 blockers like Pepsid AC, Tagament, Zantac, etc. Just be careful with combos (H2 Blockers plus antacids) like Pepsid Complete and treat them like a simple antacid, in other words don't take at same time as the riba.
As to Atkins, I don't consider that even a high fiber diet, so would not be concerned. May I ask why you're on Atkins btw? If it's for weight loss, you may find SOC your friend in that regard, but as many here have found, be careful what you wish for because sometimes we lose more weight than we wish. Also, many have found sticking to a diet difficult on tx as our taste buds and appetite change, so just try and be flexible and take it as it comes as to diet.
As mentioned, taking riba with a high-fat snack (high-fat meal better) has been shown to increased riba absorption. I took mine with my two big meals of the day but that was easy because I only at twice a day on treatment. I took them just before my first bite but taking them during the meal (or right after) should also work. Just found taking them just before the first bite was easier to remember. Riba does not have to be taken 12 hours apart according to several doctors (and a riba researher) I spoke to as it has a very long half life. I ate bkfast between 10-12 and dinner between 4-6 so my riba doses were sometimes only 4 hours apart. The main thing is that I took the riba with my meals which had fat in them.
Peanut butter and sesasme butter are fine with the riba and restricting iron really has more to do with taking iron supplements (don't unless your doc says to) than iron rich foods. Some have been told to avoid iron cookware.
-- Jim
As to Atkins, I don't consider that even a high fiber diet, so would not be concerned. May I ask why you're on Atkins btw? If it's for weight loss, you may find SOC your friend in that regard, but as many here have found, be careful what you wish for because sometimes we lose more weight than we wish. Also, many have found sticking to a diet difficult on tx as our taste buds and appetite change, so just try and be flexible and take it as it comes as to diet.
As mentioned, taking riba with a high-fat snack (high-fat meal better) has been shown to increased riba absorption. I took mine with my two big meals of the day but that was easy because I only at twice a day on treatment. I took them just before my first bite but taking them during the meal (or right after) should also work. Just found taking them just before the first bite was easier to remember. Riba does not have to be taken 12 hours apart according to several doctors (and a riba researher) I spoke to as it has a very long half life. I ate bkfast between 10-12 and dinner between 4-6 so my riba doses were sometimes only 4 hours apart. The main thing is that I took the riba with my meals which had fat in them.
Peanut butter and sesasme butter are fine with the riba and restricting iron really has more to do with taking iron supplements (don't unless your doc says to) than iron rich foods. Some have been told to avoid iron cookware.
-- Jim
the magic word, ice cream! You do need the fat, you will find, a lot of foods have fat in them naturally, Tx is the one time you should not worry over much oh what you eat.
The fat trick helped me, it does work, it also helps with nasuea, NY is right you need it.
Whole grains are ok, nuts, ect. but to much fiber may mess you up around wk 20,
Best of luck!
Deb
The fat trick helped me, it does work, it also helps with nasuea, NY is right you need it.
Whole grains are ok, nuts, ect. but to much fiber may mess you up around wk 20,
Best of luck!
Deb
I try to eat my fibre in the middle of the day. For breakfast I have oatmeal with Virgin Coconut Oil in it and full fat organic acidopholis yogurt, I then follow that with a teaspoon of fish oil for omega 3 and 6. Sometimes I also add a chunk of cheese. I have regular dinners and just try to add some healthy oil for cooking or as a salad dressing to keep the fat content up. If I'm concerned that there wasn't enough natural fat in my meal I take a couple of teaspoons of tahini with my riba, or have some ice cream. At first I thought I would put on weight but I seem to sitting pretty stable at th weight I started treatment on.
peanut butter and sesame butter are high in iron so don't get carried away with these.
everybody on tx also needs to watch for iron overload and demand the test be done..which not all clinics do automatically.
as your HGB drops from the Riba/Inf your free tranferrin rises, and if you eat red meat and other things high in iron you can end up with damaging amounts. The iron gets deposited in liver, brain and elsewhere. The oxidation the excess iron causes leads to free radicals and hence hepatic cancer. So you want to watch that.
eat plenty of fiber, but eat your riba meals with low fiber for best absorption.
particularly at the beginning of treatment you want to get the best absorption of that drug...and get UND as soon as possible so nothing that binds to the riba should be eaten. I either ate a little cheese and bread...or half a klondike bar...or a few bites of oatmeal....just something to coat the tummy...so the drugs don't chew it up....
everybody on tx also needs to watch for iron overload and demand the test be done..which not all clinics do automatically.
as your HGB drops from the Riba/Inf your free tranferrin rises, and if you eat red meat and other things high in iron you can end up with damaging amounts. The iron gets deposited in liver, brain and elsewhere. The oxidation the excess iron causes leads to free radicals and hence hepatic cancer. So you want to watch that.
eat plenty of fiber, but eat your riba meals with low fiber for best absorption.
particularly at the beginning of treatment you want to get the best absorption of that drug...and get UND as soon as possible so nothing that binds to the riba should be eaten. I either ate a little cheese and bread...or half a klondike bar...or a few bites of oatmeal....just something to coat the tummy...so the drugs don't chew it up....
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