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Can I take Phillips Colon Health
I have stage 4 liver cirrhosis due to hep c. Can I take Phillips Colon Health?
I am constipated. What can I take?
I am constipated. What can I take?
Hi,
Here is a bt from a study on the effectiveness of probiotics. They do help with HE.
Lactulose and Probiotics Are Effective in Preventing Recurrent Hepatic Encephalopathy
Posted: 10 Sep 2012 06:15 PM PDT
Both treatments were significantly more effective than placebo.
Hepatic encephalopathy (HE) is a common complication of hepatic cirrhosis. Lactulose has been effective in treating patients with acute or recurrent HE, but data supporting its use are lacking. Probiotics might also be beneficial for these patients, by altering gut flora to reduce ammonia production, although few studies have evaluated probiotics in this setting.
Now, investigators have conducted an open-label, randomized, controlled trial to evaluate the efficacy of lactulose and probiotics in 235 consecutive cirrhotic patients at a single hospital in India who had recovered from HE and had not received any HE medication. Patients were randomized to lactulose (30 mL 3 times daily), probiotics (1 capsule containing 112.5 billion viable lyophilized bacteria 3 times daily), or placebo. The primary endpoint was development of overt HE, according to West Haven criteria.
During 12-month follow-up, recurrent HE developed in more patients receiving placebo (37) than lactulose (18; P=0.001) or probiotics (22; P=0.02). Rates of hospitalization and death from causes other than HE were similar among the three groups.
Comment: Although unblinded, this study was large and well executed. It demonstrated that lactulose and probiotics are similarly effective in secondary prophylaxis of HE. Whether all probiotics would be as effective is unclear, but we now potentially have other therapeutic options for preventing recurrent HE in addition to rifaximin plus lactulose (JW Gastroenterol Mar 24 2010).
— Atif Zaman, MD, MPH
Published in Journal Watch Gastroenterology August 10, 2012
Citation(s):
Agrawal A et al. Secondary prophylaxis of hepatic encephalopathy in cirrhosis: An open-label, randomized controlled trial of lactulose, probiotics, and no therapy. Am J Gastroenterol 2012 Jul; 107:1043.
Here is a bt from a study on the effectiveness of probiotics. They do help with HE.
Lactulose and Probiotics Are Effective in Preventing Recurrent Hepatic Encephalopathy
Posted: 10 Sep 2012 06:15 PM PDT
Both treatments were significantly more effective than placebo.
Hepatic encephalopathy (HE) is a common complication of hepatic cirrhosis. Lactulose has been effective in treating patients with acute or recurrent HE, but data supporting its use are lacking. Probiotics might also be beneficial for these patients, by altering gut flora to reduce ammonia production, although few studies have evaluated probiotics in this setting.
Now, investigators have conducted an open-label, randomized, controlled trial to evaluate the efficacy of lactulose and probiotics in 235 consecutive cirrhotic patients at a single hospital in India who had recovered from HE and had not received any HE medication. Patients were randomized to lactulose (30 mL 3 times daily), probiotics (1 capsule containing 112.5 billion viable lyophilized bacteria 3 times daily), or placebo. The primary endpoint was development of overt HE, according to West Haven criteria.
During 12-month follow-up, recurrent HE developed in more patients receiving placebo (37) than lactulose (18; P=0.001) or probiotics (22; P=0.02). Rates of hospitalization and death from causes other than HE were similar among the three groups.
Comment: Although unblinded, this study was large and well executed. It demonstrated that lactulose and probiotics are similarly effective in secondary prophylaxis of HE. Whether all probiotics would be as effective is unclear, but we now potentially have other therapeutic options for preventing recurrent HE in addition to rifaximin plus lactulose (JW Gastroenterol Mar 24 2010).
— Atif Zaman, MD, MPH
Published in Journal Watch Gastroenterology August 10, 2012
Citation(s):
Agrawal A et al. Secondary prophylaxis of hepatic encephalopathy in cirrhosis: An open-label, randomized controlled trial of lactulose, probiotics, and no therapy. Am J Gastroenterol 2012 Jul; 107:1043.
Good diet can always help. Up your fruit intake. Avoid cheese. Eat lots of veggies and salads. I never had constipation before my transplant despite being very sick. I also took probiotics, omega fish oil and a host of others.
There's no question lactulose works as a laxative ! It can work too well.
Cean: I could control the hand flapping. My hepatolgoist would check but didn't put too much credence into it by itself. The fact my hands were up there I'd hold them stiff. At home, when relaxed I noticed they did flap a bit.
Hector is so right about HE. I still only remember parts of that one episode that got me into the ER in a state of delirium.
There's no question lactulose works as a laxative ! It can work too well.
Cean: I could control the hand flapping. My hepatolgoist would check but didn't put too much credence into it by itself. The fact my hands were up there I'd hold them stiff. At home, when relaxed I noticed they did flap a bit.
Hector is so right about HE. I still only remember parts of that one episode that got me into the ER in a state of delirium.
Thanks so much Hector, I'm very grateful for the education I always receive from you.
COMMUNITY LEADER
I don't know how advanced Naugatuck's cirrhosis is. If constipation is a major serious issue (and it is for cirrhotics with HE) then he should talk to his doctor about either being prescribed Lactulose or titrating the dosage of Lactulose he is taking.
Asterixis or "hand-flapping" only occurs at grade 2 when HE is fully manifest. It is now believed by most hepatologists the their exists Minimal HE (MHE). That is not as easy to diagnosis. But a good hepatologist should be observant of your state of mind during visits. Mine always writes in my reports my mental status and responses.
West Haven Criteria for Semiquantative Grading of HE
Grade 1
Trivial lack of awareness
Euphoria or anxiety
Shortened attention span
Impaired performance of addition
Grade 2
Asterixis/"Hand-flapping"
Lethargy or apathy
Minimal disorientation for time or place
Subtle personality change
Inappropriate behavior
Impaired performance of subtraction
Grade 3
Somnolence to semistupor, but responsive to verbal stimuli
Confusion
Gross disorientation
Grade 4
Coma (unresponsive to verbal or noxious stimuli)
Remember HE is a complication of cirrhosis that occurs when a patient decompensates. Basically the liver is so damaged that it is unable to perform its blood filtering tasks so the toxins from our food (such as ammonia created when we are digesting food) travel in the blood to the brain and are toxic to the brain. It appears when patients have other signs of decompensated cirrhosis. Usually after or around the same time as the first instance of ascites.
"Brain fog" and HE are two different mental states. If you look at the symptoms for each you can see the difference. I have experienced both and have never thought of them as being similar. From what I have read and is the experience of myself and other transplant patients I know these are some of the most common symptoms we have experinced.
* Short term memory loss. Can't remember my cousin's or friend's name.
* Loss of coordination (This is why patients with HE are told not to drive). They may also stumble and fall down often.
* Unable to type or write. Can't control fingers, many typos, sloppy handwriting even your own signature.
* Day and night reversal. Can't sleep at night maybe sleep part of the day). Sleep issues are universal in patients with decompensated cirrhosis. In the last 6 months I would say I average 3-5 hours of broken sleep at most. Even though I am always fatigued and sometimes can't walk a block. I can not get a good night's sleep ever.
* Another very common symptoms of HE is getting lost in a familiar environment. It could be in your own home. You don't know where you are, why you are there, or what you are suppose to be doing. Very scary.
* As HE gets worse the patient starts to experience personality changes and have strange behaviors.
* A friend of mine told his sons to paint a fence white at 10 pm.
* A patient will talk complete nonsense about something esoteric.
* They may becomes easily aggravated.
* They may walk like they are in a drunken stupor and slur their words.
* A person my not recognize their own family members.
* The most dangerous symptom is a coma which can be life-threatening. A patient in a coma should be taken ASAP to the ER. They will be hospitalized and given Lactulose enemas to clear the bowels and toxins.
Another thing to keep in mind is that many people who have HE, don't realize that they are acting oddly. It is like the drunk that thinks he is drive fine when he is weaving all over the road. The brain is poisoned so its ability to recognize what is happening is limited. When a patient experiences the worse grades of HE they don't remember anything of what happened. They can lose days of time when they are hospitalized for HE.
Unless you have had an episode of decompensation I wouldn't worry about having HE. (For those with HE, constipation can trigger a serious HE episode. So we take enough Lactulose to have 3-4 bowel movements a day).
But I would talk to my gastro to find out why you get constipated often. It could be as easy as you are not taking in enough fluids or fiber.
Hector
Asterixis or "hand-flapping" only occurs at grade 2 when HE is fully manifest. It is now believed by most hepatologists the their exists Minimal HE (MHE). That is not as easy to diagnosis. But a good hepatologist should be observant of your state of mind during visits. Mine always writes in my reports my mental status and responses.
West Haven Criteria for Semiquantative Grading of HE
Grade 1
Trivial lack of awareness
Euphoria or anxiety
Shortened attention span
Impaired performance of addition
Grade 2
Asterixis/"Hand-flapping"
Lethargy or apathy
Minimal disorientation for time or place
Subtle personality change
Inappropriate behavior
Impaired performance of subtraction
Grade 3
Somnolence to semistupor, but responsive to verbal stimuli
Confusion
Gross disorientation
Grade 4
Coma (unresponsive to verbal or noxious stimuli)
Remember HE is a complication of cirrhosis that occurs when a patient decompensates. Basically the liver is so damaged that it is unable to perform its blood filtering tasks so the toxins from our food (such as ammonia created when we are digesting food) travel in the blood to the brain and are toxic to the brain. It appears when patients have other signs of decompensated cirrhosis. Usually after or around the same time as the first instance of ascites.
"Brain fog" and HE are two different mental states. If you look at the symptoms for each you can see the difference. I have experienced both and have never thought of them as being similar. From what I have read and is the experience of myself and other transplant patients I know these are some of the most common symptoms we have experinced.
* Short term memory loss. Can't remember my cousin's or friend's name.
* Loss of coordination (This is why patients with HE are told not to drive). They may also stumble and fall down often.
* Unable to type or write. Can't control fingers, many typos, sloppy handwriting even your own signature.
* Day and night reversal. Can't sleep at night maybe sleep part of the day). Sleep issues are universal in patients with decompensated cirrhosis. In the last 6 months I would say I average 3-5 hours of broken sleep at most. Even though I am always fatigued and sometimes can't walk a block. I can not get a good night's sleep ever.
* Another very common symptoms of HE is getting lost in a familiar environment. It could be in your own home. You don't know where you are, why you are there, or what you are suppose to be doing. Very scary.
* As HE gets worse the patient starts to experience personality changes and have strange behaviors.
* A friend of mine told his sons to paint a fence white at 10 pm.
* A patient will talk complete nonsense about something esoteric.
* They may becomes easily aggravated.
* They may walk like they are in a drunken stupor and slur their words.
* A person my not recognize their own family members.
* The most dangerous symptom is a coma which can be life-threatening. A patient in a coma should be taken ASAP to the ER. They will be hospitalized and given Lactulose enemas to clear the bowels and toxins.
Another thing to keep in mind is that many people who have HE, don't realize that they are acting oddly. It is like the drunk that thinks he is drive fine when he is weaving all over the road. The brain is poisoned so its ability to recognize what is happening is limited. When a patient experiences the worse grades of HE they don't remember anything of what happened. They can lose days of time when they are hospitalized for HE.
Unless you have had an episode of decompensation I wouldn't worry about having HE. (For those with HE, constipation can trigger a serious HE episode. So we take enough Lactulose to have 3-4 bowel movements a day).
But I would talk to my gastro to find out why you get constipated often. It could be as easy as you are not taking in enough fluids or fiber.
Hector
I thought lactulose was only given for HE . I'm cirrhotic and I am frequently constipated but my hepatologist has never suggested lactulose, he just tells me to take Miralax every day. Do you think I should ask about lactulose? My hepatologist also pays little attention when I've complained of brain fog, but seems to rely very heavily on hand-flapping (which I don't have) to look for onset of HE. I've been worrying a little more about this as I've learned more about advanced cirrhosis. What do you think, Hector? Thanks!
While you are waiting to see the Dr., the safest thing to do for constipation is to give yourself an enema and stay well hydrated.
I tend toward bowel issues as well and probiotics seem to help me have more regular bowel movements. However, if you haven't had a BM for more than a day or two I would def. do an enema.
Good luck
I tend toward bowel issues as well and probiotics seem to help me have more regular bowel movements. However, if you haven't had a BM for more than a day or two I would def. do an enema.
Good luck
COMMUNITY LEADER
If you have cirrhosis you need to seeing a hepatologist. You find a hepatologist are any liver transplant center which is usually at the largest teach hospital in your area. No other type of doctor is qualified to treat you. They will prescribe Lactulose to keep you bowel movements regular.
Phillips Colon Health is NOT a laxative so it won't help with constipation. It is a probiotic supplement that helps replenish the bacteria in your colon.
A probiotic will do nothing to help your advance liver disease either.
Talk to your doctor if constipation is a chronic issue for you.
Good luck.
Hector
Phillips Colon Health is NOT a laxative so it won't help with constipation. It is a probiotic supplement that helps replenish the bacteria in your colon.
A probiotic will do nothing to help your advance liver disease either.
Talk to your doctor if constipation is a chronic issue for you.
Good luck.
Hector
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