water consumption/riba concentration

[babs824]

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