what fat to eat with riba?

[smaug48]

I've read that fat can help with ribavirin absorption.  But I just read in another post that cheese and peanut butter (among other things) may contribute to higher ammonia levels, which in turn may cause brain fog.  Any suggestions on what fats to take with riba, both in the morning and evening?  And how much fat is necessary each time?

[smaug48]

Thanks for the info, I'm going out today to buy some avacodos!
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sfbaygirl, Jim: I am not decompensated and so far (taking shot 5 this Fri) have been lucky that I can still eat everything with no problem.  So I would like to eat healthier while I can.  Hopefully the honeymoon will last :-)
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Bill:  I especially appreciated the hard evidence, thanks for sharing.  And thanks for the wishes of good luck.
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jamimapuddle: I hear you on the illusion of thinking we can influence this thing - but we don't know for sure, we gotta try if we can, right?  I guess we just shouldn't get too anxious about it.  
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Thanks again for the support

smaug

[sfbaygirl]

I did seem to gain a bit of weight on tx with all the fat for the Riba, after tx I lost 30 lbs. I have kept it off and my hep dr. says I should keep it that way.  I weigh what I did in high school. Of course I am happy with that. The pain has kept my appetite non existance. Now that I am feeling better, I sure hope I don't start going up.

[whoaisme]

I used to give my husband a granola bar to eat along with the riba, that seemed to be ok.

[jamimapuddle]

Does anyone remember that post about unsaturated fats being bad for your liver (I think it was about two months ago) ?.  Some posted a study about it, then HR replied and said as long as your taking Nac/vitc, ALA, and a few more which I forgot, they should counteract the bad effect on the liver which unsaturated fats have.  Does anyone else remember this post?

Anyway, I try to do the 53grams of fat for breakfast and dinner with my riba.  I've been trying to mix it up; olive oil,avocados,peanut butter(all natural organic kind),walnuts,whole milk,and lots of cheese.

I sure hope it helps my chances for svr because I put a lot of work into it!  Sometimes I think that all it does is add the illusion of control to a situation in which I have little.

[jmjm530]

If you're one of the lucky ones on treatment who can pick and choose what they can eat, then pick "healthy" fats -- the "good"  fats like Olive Oil or Almond butter  -- as opposed to the saturated fats like butter. But if you're like some of us -- and that was my case when treating -- who have a hard time finding anything appetizing to eat (often combined with significant weight loss) then just eat whatever fat will give you the calories, energy and weight to continue on -- be it ice cream, pizza, cheese omelets of cheese cake.

Just a word to the wise, all good things come to an end, so be aware that your eating habits on the treatment drugs can potentially cause a significant weight gain when you stop taking the drugs -- and a lot of that weight can come back as fat.

That said, the bottom line is do what it takes -- obviously within reason -- to get through treatment. So if it takes an ice cream Sunday every other day to maintain weight and keep that riba flowing-- well it's a tough job but somebody's got to do it :)

-- Jim

[Bill1954]

Hi Linda,

I’m still compensated, late stage 3, early 4 by biopsy three years ago. I don’t know about smaug or wed.

I’m just trying to point out that I don’t think there is any documented evidence that limiting animal protein is the preferred method for controlling encephalopathy.

I can eat like a horse during treatment if I don’t watch myself… I always gain weight on Tx…

Wishing you the best,

Bill

[sfbaygirl]

Are you decomensated, is Smaug?  I'm with Susan on this.  I had a tough time eating anything, so ice cream for breakfast worked for me. Avacado was good too.  With my appetitie being so bad anything that I could put down was good and I made sure about that fat for the Riba.  Yeah, if the liver is decompensated, that is a different story I assume, but for us that isn't a problem, I felt lucky to put anything down my throat during tx.

[Bill1954]

Thanks for posting the info. While I’m certainly not questioning the info that you’re dietician gave you, I do wonder if he/she is able to interpret the relative benefits that animal proteins might have on liver synthesis, etc.

Again, I don’t believe it’s and issue until the patient is showing signs of decompensation, and even then, I think the preferred method of management is currently Lactalose. Perhaps we’ll hear from some of our cirrhotic patients that are currently dealing with this issue.

Thanks again,

Bill  

[wed1942]

Just got info from my dietician at work about nutrition and liver disease. It does mention avoiding animal sources of protein. Says to eat vegetable protein. Also said to avoid gelatin (jello), cheese, salami, peanut butter and onions. These produce more ammonia. States that if the ammonia levels get too high can lead to confusion, lethargy and coma (hepatic encephalopathy).  It is very confusing. Hope this helps.

[Bill1954]

From Schering Plough:

http://tinyurl.com/2ve8sw

“Effect of Food on Absorption of Ribavirin Both AUC and C max increased by 70% 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.”

Last year I met with an educating nurse with SP; and although she acknowledged that dietary fat increases absorption, she denied knowledge of any studies that associated ingesting ribavirin with dietary fats and increased SVR rates.

Animal proteins can contribute to elevated serum ammonia levels in patients with decompensated cirrhosis, but I wouldn’t expect that would be a problem in lieu of that diagnosis.

I understand that years ago, cirrhotic patients were advised to limit dietary animal proteins to limit serum ammonia, and subsequent hepatic encephalopathy. In most cases, I believe medicine has recognized the importance of proteins, and now primarily controls with Lactalose.

I’m personally unaware of any documented info that discourages the intake of peanut butter.

Common sense stuff; olive oil, nuts, nut butters, and dairy products in a ratio that reflects the amounts shown above.

Best of luck to you,

Bill

[anwaar]

Wow!  you got it covered!  I should have read yours first!  Now I've got to go eat, you've made me hungry!

[anwaar]

I'm fairly new and not on treatment.  I've read about this ribavarin w/fat.  
I'm familiar with healthy eating and getting the 'proper' amounts of fat.  Peanut butter from the stores and 'among other things' of which you speak, are saturated fats.  
Good fats are 'unsaturated fats' such as oily fish, avocados, nuts, seeds, OLIVE oil.
Do you like fish?  (Salmon, mackerel, herring, and others) - good fats, plus omega3 fatty acids.
This is a start... and sure others have ideas.

[susan400]

Here's a couple of suggestions:  1 cup of ice cream,  1 Jello Pudding cup, regular kind - not the fat-free.  Unless you've had some abnormal ammonia levels in the past, don't concern yourself with that at this time-while you're treating.

[jdwithhcv]

How about avocado, also olive oil should be ok (I hope.)  For me a scrambled egg with a side of salsa and avocado is good in the morning.  Olive oil is my mainstay fat source for cooking, dipping bread, dressing veggies/salads.  I sometimes take the evening pills with a Dannon Frusion peach yogurt smoothie.  I think a moderate amount of fat gets it done, not sure we need large portions.

Its so confusing!  Every time I find something I can eat it either turns out to be a bad idea or else that food starts to really turn me off.