water consumption/riba concentration

i read that early riba concentration might possibly effect success rate of tx. I wonder if drinking the quantity of water recommended (half body weight) might dilute or wash through the riba faster and lesson the positive effect. i have been eating cheese with riba as i have heard that it will keep the concentration longer. any thoughts?

[Trinity4]

I think the key is to drink as much water as you are comfortable with.  You want to stay well hydrated but half the body weight isn't a magic number we absolutely have to strive for.  There isn't any danger of diluting the riba if you are consuming an abundance of liquid.  As a matter of fact, taking riba with meals usually provides enough fat for adequate riba absorption.  We tend to say take the riba with a higher fat food to ensure absorption if your food intake is not sufficient.  

Trinity

[maxygirl]

No harm in as much water as possible.  In fact the water will help to relieve some side effects.  The drugs cause you to dehydrate.

[Diane12855]

The Riba really does dehydrate you. If I drank this much water before starting tx I would have been spending all of my time in the bathroom, but not now. I also notice that my sx get worse if I don't drink enough water so you really don't want to cut back too much.

Diane

[missy_jasons_girl]

Mine too, if I don't drink enough water my sx are worse!!

[Trish77]

" As a matter of fact, taking riba with meals usually provides enough fat for adequate riba absorption.  We tend to say take the riba with a higher fat food to ensure absorption if your food intake is not sufficient.  "

Can you please cite your source information for this?

From my perspective, this is incorrect and counselling people that any meal is sufficient to maximize riba absorption would be misleading.  The higher the fat content, the higher the absorption factor.  It was found that riba absorption increased considerably when increasing the fat content of the meal.  So just eating food alone isn't enough.  It truly does have to be food with high fat content to maximize ribavirin absorption.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1804105

"The component of the final population pharmacokinetic model that describes the absorption phase is complex. Although a standard meal did not affect ribavirin bioavailability (F1), administration of ribavirin with a high-fat meal increased bioavailability by 46% relative to the fasting state. A high-fat meal prolonged the duration of the zero-order input part of the absorption model, with D1 increasing from 0.498 h (fasting and standard meal) to 0.740 h. The type of meal also influenced the first-order input part of the absorption model (Table 1)."

That's a pretty high increase of bioavailability of ribavirin by 46% by making that meal high-fat, whereas a "standard" meal had no impact or increase on bioavailability.  It clearly seems to matter not only that you eat but WHAT you eat with regards to maximizing the absorption of ribavirin.  If you have studies that shows otherwise, please post it.

[copyman]

I think drinking enough water / juice that you are comfortable with is adequate. Half the body weight in oz's of water is just an internet myth and not necessary. Your body will let you know when to drink.
And yes I do believe to much water can dilute the riba. Don't misunderstand, you do have to stay hydrated with these meds but don't have to drown yourself doing it.

[Trinity4]

Firstly, I'm not counseling anyone and thank you for pointing out how erroneous and misleading I can be. But then again, it's from your perspective  I certainly won't get an "A" on that post.   I'm talking foods that are high in fat content 3 x day.  If you have an exact fat gram intake needed to increase the bioavailability to 46% I'd like to see that too.  My diet consisted of enough healthy fats without adding things like bacon and eggs every morning, peanut butter milkshakes, gobs of ice cream, desserts etc.  It's not necessary to add additional fat to the diet if you know WHAT you are eating and in my case I did.  

I will try find the data I have showing normal diet is sufficient.

[Trish77]

"Firstly, I'm not counseling anyone and thank you for pointing out how erroneous and misleading I can be."

You're being a bit sensitive.  I was disagreeing with your opinion/information and I don't think I was disrespectful about it.  If your own diet is high in fat content then sure, taking riba with a standard-for-you meal is sufficient and doesn't require adding fat content.  Your comment was a general one and stated that you only needed to add fat content if your food intake was insufficient, not if your fat content was insufficient.  

That's misleading and riba absorption is *important* so I provided the data to correct that, so that people don't think that just any old food is sufficient. Don't take it personally, it's important to provide correct data and you know that, you've provided plenty of correction yourself.  Not everybody is going to be 100% with the data they serve up here and what's important is that the data is correct, not that YOU are correct.  

If you have data showing normal diet is sufficient, that's great.  Post it.  And we'll all keep learning from each other. Otherwise, simply have the information stand corrected so that people can manage their treatment most effectively and as successfully as possible.  That's what it's all about, right?  

[Bill1954]

From Schering-Ploughs PEG-Intron prescribing info:

http://www.spfiles.com/pipeg-intron.pdf

Effect of food on absorption of ribavirin:

Both AUC and C-MAX increased by seventy percent when Rebetol Capsules were administered with a high fat meal: (841 kcal, 53.8 g fat, 31.6 g protein, and 57.4 g carbohydrate) in a single-dose pharmacokinetic study.

[mikesimon]

Although a standard meal did not affect ribavirin bioavailability (F1),

[Trinity4]

Thank you Bill.  For example, a Mickey D's quarter pounder and cheese has 24 grams of fat.  Their big breakfast has 36 grams.  Recommend fat grams with riba is 53.8 grams so it's easy to do the math.  I ate normal home cooked meals such as meatloaf, chops, steak, cheese dishes, creamed potatoes that weren't necessarily the most healthy but nutritionally balanced along with a healthy breakfast of cereal, milk, fruit, toast and butter. Adding lunch and additional food throughout the day I'm sure the fat grams were well above the recommended level.  There were days I couldn't eat and would supplement a couple tablespoons of peanut butter for higher fat to take with the riba.  Specifically, omitting  the "fat content" in my statement about food intake could have been misleading but common sense should prevail.

Trinity

[Diane12855]

I'm finding this a little disconcerting. If a MD Quarter Pounder only has 24 grams of fat... that's almost 30 grams too low. I don't ever eat more fat than that.

So this means we need to eat a minimum of 107.6 grams of fat per day? Lord have mercy! And I'm already gaining weight from my decreased physical activity... I'll be as big around as I am tall in 23 more weeks!

2 Tbsp of crunchy peanut butter is only 15 grams of fat.
1 cup of whole milk is only 8 grams of fat.

This tells me that we need to come up with better sources of fats... especially for the slower responders.

Diane

[Diane12855]

You do realize that half your body weight is like.... if you weigh 140 lb, you drink 70 oz of water a day. That's 7 * 10oz glasses per day. My nurse told me that that also includes the coffee you drink, the milk you put in your cereal etc.

We need to remember that everything that goes into our mouth gets all mixed up in our stomach and doesn't start getting into our blood stream until it reaches the small intestine (except for a few exceptions like alcohol and aspirin which go straight through the wall of the stomach to the blood stream) Just drinking straight water doesn't mean that it is pure water by the time it reaches the small intestine... unless we are starving ourselves.

Just a little extra info there.............

Diane

[Trinity4]

Adequate serum ribavirin levels do not hinge on fat intake. While fat helps in the absorption process some people regardless of fat intake do not metabolize ribavirin as effectively as others.  Dosage would need to be increased in order to maintain adequate serum levels.

Trinity

[nygirl7]

I do agree that there is most certainly a limit to how much fat you want to ingest on a daily basis just to get the upmost amount of riba that you can.  Jez have we not all seen how high our cholesterol levels go up after treatment once our livers start working again? My doctor is freaking out about this (my PCP he doesn't really understand why) This is a COMMON problem. I remember it was Jim who ate a basic eggs and bacon meal every morning I think - certainly in this day of American excess and being the fattest country in the world - I think we get plenty. That is not to say I would not make SURE I was having something with a high fat content it's not always that easy for us to eat on treatment.  You do what you can and monitor your hgb. Throw some half and half in your coffee and eat some peanut butter crackers and that's probably going to do it.  Dont have to pound down the double cheeseburgers for breakfast (although you know me I would love to do that, yum).

While I do believe that fat is necessary to bind the riba, I found that if I could take a yogurt shake in the morning some mornings that was all I could do.....certainly I took more riba than most in my complete paranoia however reflective of my incredibly big hemo drop I would say it was binding to something.........and I drank half the ounces of water every single day just pounding down those bottles.  Something obviously did work.


I did however wait a few hours to really drink that water...just in case.

but I was paranoid about it and have never said otherwise.

I give my paper an A by the way because it's all true and logical.

[Trinity4]

My perspective is you have earned an "A" and I grade you accordingly.

:) Trin

[nygirl7]

PS  1 cup of whole milk is only 8 grams of fat.

You see on tv commercials that they say a 2% glass of milk is = to a small McDs french fries...........so really when you think about it, there has to be plenty enough fat in that whole milk right?  Just pure common sense God didn't intend us earthlings to go around eating fries all day long I don't think but rather apples (well maybe pomegranets or whatever was over in the Garden of Eden ;)

There now maybe I have earned an A+?   ;)

[GSDgirl]

I did not find this forum until I was just about finished with TX.  I did not know about eating fat or drinking so much water / liquids.  So most of the time I took my riba on an empty stomach.  I am not telling anyone they don't have to eat fat by any means.  I did clear and was still clear 2 years post in March.  I guess I got lucky.

Denise

[nygirl7]

Here is an interesting tidbit re: McDonalds...........scary scary scary that we feed this to our little kids and get them their toys. God.

You want flies with that? McDonald's Happy Meal shows no sign of decomposing ...  
Daily Mail - ‎6 hours ago‎

http://www.dailymail.co.uk/news/article-1319562/McDonalds-Happy-Meal-bought-Sally-Davies-shows-sign-mould-6-months.html


By Daily Mail Reporter Looking almost as fresh as the day it was bought, this McDonald's Happy Meal is in fact a staggering six months old.
Happy Meal Still Going Strong 6 Months Later NPR Happy Meal Doesn't Decompose After 6 Months CBS News
Reuters - msnbc.com - KTAR.com - Orlando Sentinel (blog)
all 57 news articles »

[Trish77]

That's good information, Bill.  Thank you.

This needs to be kept in perspective.  Nobody is saying, including myself, that SVR itself hinges on taking your ribavirin with a high-fat meal.  That would be going way too far.  It's simply one other way to maximize treatment as much as possible with any tools at our disposal.  

Nobody is talking about being irresponsible with fat either and recommending that you eat a total fast food diet - that's blowing things way out of proportion.  There are good fats and they can be taken WITH ribavirin to maximize the absorption.  I always took fat with my ribavirin and tried to make it good fat - peanut butter with my toast, etc.  There were also days that I was so bloody nauseous that I ate whatever I could stomach and it wasn't exactly Canada's Food Guide recommended.  

No...eating a high-fat meal with your ribavirin will not correct other issues that may be interfering with getting the full benefit of treatment drugs.  However, at least it might make up for some of those other situations that may be at play and we do what we can.

In a nutshell, it's GOOD information that taking your ribavirin with high-fat food can aid in the absorption factor and there is documented evidence to that.  Just one more potential tool in the toolkit.

[Bill1954]

I certainly believe there is more to ribavirin absorption/metabolism than adequate dietary fat consumption. I was taking 1800-2000 mg/day riba (~22mg/kg/day) for nearly three years, and never developed anemia to the point where it required intervention. I think the lowest hemoglobin result I had through that period was 11.2 g/dL; about 12 weeks into my second treatment. I didn’t monitor dietary fat intake, but made no special efforts in that direction. I’d characterize my diet as moderate in all dimensions.

Good luck to all—

Bill

[babs824]

thanks for a fascinating discussion. i dont mind upping my fat intake and would love to drink milkshakes around the clock but at my age with high cholesterol i think i will go out and buy some avocados as diane suggested and refill my almond/walnut supply. u guys are great!

[nygirl7]

Thats exactly what I did Babs - ice cream ice cream ice cream it was about all I could really eat on treatment.  I certainly had 10 peoples fat share I guarantee you that! unfortunately after treatment I didn't really, really understand that I had better stop.......and voila boy oh boy all of a sudden I was like huh not so skinny and emaciated after all are you girl?

So that is my word of advice.......fat = good with riba but don't do what I did or cholesterol levels are not the only thing that will go up and boy are they hard to get DOWN.   ;)

[GSDgirl]

I was able to drink milkshakes using carnation instant breakfast, ice cream and milk.  At times that was all I was able to get down.

I gave up fighting my doc and am on zocor for the cholesterol

[nygirl7]

I first saw this yesterday but it seems applicable now.  Good news for those who are obese and dealing with diabetes and all that stuff.....

US scientists have identified a fat enzyme link to hepatitis C virus (HCV). This discovery may offer a new strategy for treating the infection.

More than 160 million people are infected throughout the world, and no vaccine is available to prevent further spread of the disease. Current treatments are not effective against the most common strains in the US and Europe. A study at the Gladstone Institute of Virology and Immunology (GIVI), published in the journal Nature Medicine, shows that the enzyme DGAT1 is a key factor in HCV infection. With several potential DGAT1 inhibitors already in the drug-development pipeline, a treatment for HCV may be possible in the near future.

“Our results reveal a potential ‘Achilles heel’ for HCV infection,” said Melanie Ott, MD, PhD, senior author on the study. “Several DGAT1 inhibitors are already in early clinical trials to treat obesity-associated diseases. They might also work against HCV.”

At first glance, the HCV lifecycle is fairly simple. The virus enters the cell. One large protein is produced and cut into several smaller viral enzymes and proteins that build the virus. The RNA genome is copied, and the new RNAs and structural proteins are used to make new virus particles that are released into the blood stream for to infect more cells. These processes were thought to occur at specialized membranes inside the cell. However, recently it has been shown that fat droplets are critically involved

Fat droplets, which store fat in cells, have become a hot new topic in biology. DGAT1 is one of the enzymes that help to form fat droplets. The Gladstone team, led by Eva Herker, PhD, discovered that HCV infection and viral particle production are severely impaired in liver cells that lack DGAT1 activity.

DGAT enzymes produce the fat that is stored in the droplets that are important for HCV replication, so we wondered if inhibiting those enzymes might disrupt the viral life cycle,” said Dr. Herker. “We found that HCV specifically relies on one DGAT enzymes, DGAT1. When we inhibit DGAT1 with a drug, the liver still produces fat droplets through another DGAT enzyme but these droplets cannot be used by HCV.”

The team sought to identify which step in the HCV lifecycle requires DGAT1. They found that DGAT1 interacts with one viral protein, the viral nucleocapsid core protein, required for viral particle assembly. The core protein normally associates with the surface of fat droplets but cannot do so when DGAT1 is inhibited or missing in infected cells.

Researchers at Gladstone Institute of Cardiovascular Disease had previously cloned DGAT1. Gladstone Institutes is a nonprofit, independent research and educational institution.

Charles Harris, Robert V. Farese, Jr. and Katrin Kaehlcke were part of the Gladstone team. Celine Hernadez, Arnaud Charpentier and Arielle Rosenberg supported the research from the Universite Paris Descartes.

This work was supported by funds from the Gladstone Institutes, the Hellman Family Foundation, the US National Institutes of Health and the UCSF Liver Center. Additional support was provided through fellowships from the Human Frontiers Science Program, the Agence nationale de recherches sur le sida et les hépatites virales, and a training grant from the National Institute of Diabetes and Digestive and Kidney Diseases.


Read more: Fat Enzyme Link To Hepatitis C Identified - Page 2 http://www.medindia.net/news/Fat-Enzyme-Link-To-Hepatitis-C-Identified-75297-2.htm#ixzz12GpX8jow


Read more: Fat Enzyme Link To Hepatitis C Identified http://www.medindia.net/news/Fat-Enzyme-Link-To-Hepatitis-C-Identified-75297-1.htm#ixzz12Gp6jNgG

[Trish77]

Diane12855:  "So this means we need to eat a minimum of 107.6 grams of fat per day? Lord have mercy! And I'm already gaining weight from my decreased physical activity... I'll be as big around as I am tall in 23 more weeks! "

Nowhere does it say that you need to eat a minimum of 107.6 grams of fat.  I'm guessing you took the 53.8g used in the study and doubled it for two riba doses a day to come up with that. The 53.8g of fat that produced a 70% increase in bioavailability was the amount used on the study to determine the impact of fat on riba's bioavailability.  They weren't testing to determine appropriate fat "dosages" and it isn't a fat "dosage" recommendation.  Use some common sense - not talking eat tablespoons of Crisco with your riba - however a sensibly considered high-fat meal is a good move to potentially increase riba absorption, in my perspective.  And sometimes....go for the maple walnut ice cream, just because. :)

Bill:  I look at it similar to how I approached it when my doc suggested I add Folic Acid to my regimen when my hgb tanked.  I'd read that it really has very little impact.  My doc countered with the fact that studies show it has a positive impact on 20% of the folks who take it.  That was enough for me...I wanted my hgb to go up, I took the Folic Acid in case I was in the 20%.  From what I've read on high-fat with riba, it was enough for me to make that part of my regimen also.  

[Trinity4]

If someone is conscientious of what constitutes a higher fat meal then all is well.  Trans fats - Saturated fats are bad fats.  - Monounsaturated fats - Polyunsaturated fats are good fats.  If bacon, sausage,, ice cream and cheeseburgers, things like that are all you can eat then that is what you do.  You pay the piper later.  If your diet consists of nutritionally balanced foods with enough fat to sustain adequate riba absorption that is ideal.

Eating crackers and water isn't going to get it but if that's all you can eat then it's wise to supplement things like peanut butter or shakes daily.   A diet including nuts, grains, higher fat fruits, dairy, meats and vegetables contain adequate dietary fat to enhance riba absorption.  

It's really quite elementary.  I ate anything and everything I wanted on treatment and still lost weight.  Post treatment, I gained back what I lost but no more than that because I know the difference between good and bad fats, portion control and how high fat foods cause weight gain regardless of portion.

Trinity

[Bali05]

just to add my 2 fatty cents....
some fats that are preceived as bad but really aren`t all bad  as long as they are not heated. Fresh butter  (not that fake stuff with additives) for example has beneficial fatty acids.

[GSDgirl]

Oh Bali, I am so glad to see someone thinks the same as I do about butter.  I love the stuff.  I know, I know I don't overdo it but can't stomach the thoughts of margerine

[Bali05]

The german Liverhelp orgaization publishes a quaterly magazine with all the recent updates.
In one of the back issues they did some research with people and advanced disease and what foods
they tolerated better than others.
Butter was among the very well tolerated foods.

[Trinity4]

I used it throughout my treatment too.  Bagels with butter and cream cheese.  Yum

[Bill1954]

With butter AND cream cheese? I wanna live at your house :o)!

[GSDgirl]

Never thought of that combo but a bagel and tons of cream cheese....yummm

Bali, I have German dogs but that is about as far as my German goes.  Jagers-Tal (Hunters Valley)  is my kennel name.

[Trinity4]

GSDgirl,

I made potato soup with butter. milk and cream all through treatment.  If my stomach was upset which happened a lot during treatment it was one of the few things I could eat that would actually settle it.  My god if I ate as much of it now as I did then, I'd blow up for sure.  Same thing with the cream cheese.

[Bali05]

just because it is from germany does`nt make it any better , most of the stuff they print i usually
already know and is based on US research but it is always nice to see a different angle on the
same issues and once in a while you find something unexpected.

i don`t think drinking more or less water will influence your riba concentration. Once it is absorbed
into your body and cells it will stay there up to 6 months in certain areas.
It`s not like  water soluable vitamins that can get flushed out of your system within hours like Vit C.

[Bali05]

Some more food (fat) for thought
Would someone with a very low HgB with no available rescues and facing dose reduction
from tx team be able to raise HgB by going fat free ?

[GoofyDad]

"God didn't intend us earthlings to go around eating fries all day long I don't think but rather apples"

Hmmm.. I'm not one for the scriptures, but I'm pretty sure that it was the apple what was what we weren't supposed to eat.

[babs824]

could u sugar coat my fat? miss ya, babs

[FlGuy]

Sugar coated fat, eh.  Several years ago, I think it was test marketing a new product -  Hostess came out with a chocolate covered Twinkie called a "Chocodile"

[nygirl7]

Jez this thread just made me starving and now somebody here is toasting a bagel......it's enough to make me drool.  Screw the apples pass me the butter.

Or a chocodile.

[Trinity4]

The boss just brought in an apple strudel from the German bakery they had leftover from their big Oktoberfest soiree at their home.  Of course, I wasn't invited but I'll sure eat his apple strudel.  Enough fat grams in that to last me for the rest of the month.

Trin

[Bill1954]

I didn’t realize there was such a thing as leftover strudel…

[mountainair]

This is a very good question.  I am in the riba dose reduction Arm of a Trial.  My first impression is that impeding riba uptake isn't going to help w/ tx unless you're facing a non-medical administrative "rule" that will force you to drop out of tx.


Hey Babs!  For a while during my tx I had a craving for buttered toast w/ cinnamon sugar - so there's your sugar coated fat (I gained 3 lbs that month while on tx) LOL

[Trinity4]

This is a very interesting post written by CoWriter a while back on the subject of high fat meals with ribavirin and we all know she's a very smart lady who does her homework. An article about Hepatitis C linked to fat enzyme in liver cells will follow this post. It's common knowledge if you maintain a 3 gram drop in hemoglobin you will have the right concentration of Riba.  I
________________________________________________________________________

Should you take the Ribavirin with a high fat meal to increase the concentration????

Every time I hear people tell a newbie to take the Riba with a HIGH FAT MEAL or to eat all the ice cream they want, I cringe. So I decided to look into it. Please feel free to jump in. All comments welcome even if you don't agree with me.  

First of all, let's see what the drug company 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 to take your Riba, that would give you a total of 1682 calories.....and 964 calories would be from fat. That means that 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.

Diabetics are usually allowed a total of 1800 calories a day. So that means that after eating the two high fat meals, they'll have 118 calories left to cover one more meal and two snacks....which may cause their 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. Having some fat with your meal is fine, but do you really need 54 grams????

To help you decide, I did a little research on the effects of food on Riba bioavailability.....
(The quotes come from published data on Riba pharmacokinetics. Sources listed below)

"Bioavailability" means the portion of the dose that reaches the systemic circulation. When a medication is administered intravenously, its bioavailability is 100%. However, when a medication is administered orally, its bioavailability decreases because not all of it is absorbed. So 70% bioavailability means that, from the dose you took, 70% of it reached systemic circulation.

"Two studies have been carried out to assess the effect of food (ie, a high-fat breakfast) on the bioavailability of a SINGLE oral dose of ribavirin. An initial study by ICN Pharmaceuticals, Inc. showed MINOR EFFECTS on bioavailability, but a 33% increase in Tmax (Time to Maximum Concentration)"

In other words, a high-fat breakfast (54 grams of fat) slowed the absorption of Ribavirin by 33%. It took 33% longer to reach the maximum concentration and had only a minor effect on bioavailability. So according to that study, eating a high fat meal had no benefit.

"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."

So that means that compared to people who were fasting, eating a high fat meal (54 grams of fat), increased the maximum concentration of Riba by 70% but it took twice as long to do it. Ribavirin is rapidly absorbed following oral administration. The time to reach the Maximum Concentration of Riba after taking a single oral dose is usually 1.5 hours. After a high fat meal, it took over 3 hours to reach the maximum concentration.....but bioavailability is more important than absorption time.

"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 and the other one showed that it did.....if you ate 54 grams of fat.....as compared to people who ate nothing. That means that we don't know whether bioavailability would be 69% or 71% or whatever if people eat a regular, non high-fat meal because they didn't look at that. They compared people who ate a high fat meal to people who ate nothing.

"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.

But 70% concentration sounds so impressive, doesn't it? But remember....that was after taking ONE SINGLE DOSE of Riba. Taking multiple doses is totally different. You cannot predict what the bioavailability will be after taking multiple doses from looking at what happened after taking ONE DOSE.

"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 pertains to those of you who are planning on taking ONLY ONE Ribavirin dose....  


Fat is a good source of energy and we all need some fat in our diet. For somebody on treatment who has lost lots of weight and can't afford to loose any more, the recommendation is certainly to eat whatever they can tolerate and that includes fat. If it means survival, it's better to eat junk than to eat nothing at all. At that point, getting calories is the important thing, doesn't matter where they come from.

I have no problem with people having some fat with their Riba. But I can't agree with suggesting people starting treatment eat 54 grams of fat twice a day as suggested by the study (especially if they're already obese) to MAYBE increase Riba bioavailability. Not when multiple dosing may already be doing that. Not when up to two thirds of them may have insulin resistance and many of them have fatty liver.

A high fat diet promotes oxidative stress, fatty liver, high blood sugar, an increase in CYP2E1, cytokine-induced beta-cell death, hepatic insulin resistance and hyperinsulinemia. All the things that lower SVR.

When you become insensitive to insulin (Insulin Resistance), the pancreas increases its production of insulin....so you end up with too much insulin (hyperinsulinemia).....And large levels of insulin, MAKE INTERFERON INEFFECTIVE....and at that point, Riba bioavailability will no longer matter.

As always, the choice is yours.

[Trinity4]

Hepatitis C linked to fat enzyme in liver cells

Gladstone scientists link hepatitis C virus infection to fat enzyme in liver cells
Discovery points to a potential new strategy for treating the disease

SAN FRANCISCO, CA—October 10, 2010—Scientists at the Gladstone Institute of Virology and Immunology (GIVI) have found that an enzyme associated with the storage of fat in the liver is required for the infectious activity of the hepatitis C virus (HCV). This discovery may offer a new strategy for treating the infection.

More than 160 million people are infected throughout the world, and no vaccine is available to prevent further spread of the disease. Current treatments are not effective against the most common strains in the US and Europe. The study, published in the journal Nature Medicine, shows that the enzyme DGAT1 is a key factor in HCV infection. With several potential DGAT1 inhibitors already in the drug-development pipeline, a treatment for HCV may be possible in the near future.

"Our results reveal a potential 'Achilles heel' for HCV infection," said Melanie Ott, MD, PhD, senior author on the study. "Several DGAT1 inhibitors are already in early clinical trials to treat obesity-associated diseases. They might also work against HCV."

At first glance, the HCV lifecycle is fairly simple. The virus enters the cell. One large protein is produced and cut into several smaller viral enzymes and proteins that build the virus. The RNA genome is copied, and the new RNAs and structural proteins are used to make new virus particles that are released into the blood stream for to infect more cells. These processes were thought to occur at specialized membranes inside the cell. However, recently it has been shown that fat droplets are critically involved.

Fat droplets, which store fat in cells, have become a hot new topic in biology. DGAT1 is one of the enzymes that help to form fat droplets. The Gladstone team, led by Eva Herker, PhD, discovered that HCV infection and viral particle production are severely impaired in liver cells that lack DGAT1 activity.

"DGAT enzymes produce the fat that is stored in the droplets that are important for HCV replication, so we wondered if inhibiting those enzymes might disrupt the viral life cycle," said Dr. Herker. "We found that HCV specifically relies on one DGAT enzymes, DGAT1. When we inhibit DGAT1 with a drug, the liver still produces fat droplets through another DGAT enzyme but these droplets cannot be used by HCV."

The team sought to identify which step in the HCV lifecycle requires DGAT1. They found that DGAT1 interacts with one viral protein, the viral nucleocapsid core protein, required for viral particle assembly. The core protein normally associates with the surface of fat droplets but cannot do so when DGAT1 is inhibited or missing in infected cells.

[Gee704]

Could you tell how to figure out what a 3 gram drop in hemoglobin is?
I started at 15 and am down to 9.1. Is this a 6 gram drop?

Thanks ~

[Bali05]

good stuff from CoWriter. Thanks for digging that back up.

Gee704: Yes that is a 5.9g drop. How long did it take you to get there ?
              At what week did you start being anemic ?
              How long do you have to go ?
              Are you going to get rescue drugs ?

[Gee704]

Thanks for responding Bali!
I was down to 10.2 at week 4 and hovered between 9.6 and 10.3 until week 32 when I dropped further to 9.1. I almost felt like I was going to die. They cut my riba to 3 pills per day last Monday. To say the least, today is the best day since.

No rescue drugs and on SOC at week 34. 14 to go!

Gee~whiz

[nygirl7]

Why no rescue drugs are you in a trial?  I had a six point drop in ten days, yes I thought I was dying too. Without Procrit I never could have continued.

[Bali05]

When did you become UND ?
What was your original Riba dose ?
What is your weight and geno ?

[Gee704]

I started in the Boc anemia trial. At 10 weeks I stopped the Boc and remained on SOC. Prior to stopping the Boc, I had been randomized into the riba reduction arm. They have never offered rescue drugs and now with the Epo recall, I am unaware if it is even available. I was <25 at week 6 and UND at week 8.

Of course, I am concerned with remaining UND and even more concerned about my success rate for SVR.

Gee~whiz

[Gee704]

I became UND at week 8.
Original riba was 6 pills per day 2 @ 185 lbs. but that was cut to 5 pills at week 4 just as the Boc was added. I am now down to 155 lbs.
Geno type 1

Gee~whiz

[Bali05]

Did not know you were in a trial.
Can`t really comment on that since I don`t know the rules of that trial plus
most data I base my decisions on stems from just straight SOC.

My personl view is to take as much Riba as you can safely get away with including
rescues before dose reduction.
Also I would run the most sensitive PCR available such as LabCorps NGI QuantaSure by PCR .#140639  <2 IU