It looks like I was wrong about a low protein diet/cirrhosis

[evangelin]

It looks like I wasn't right in feeding Joe a low fat vegetarian diet after all,  I talked to a liver transplant nurse from the VA (Joe isn't a vet but I got connected to her through a friend)  and she said that the low protein recommendation for cirrhosis has been changed to high protein with more lactulose to off set the ammonia.  It seems that although the low ammonia diet really helps the foggy brain/memory problems with cirrhosis, it hastens the muscle wasting effect and in the long run, more protein with plenty of lactulose is better. I feel sad about this because being a very diligent person, I forced this dietary change on Joe because I thought it was best.  He was noticably more like his normal self when not eating the meat and other than a prescription which I insisted on, we had been given very little instruction on how to use lactulose.  I have the regret of doing the wrong thing even though I did it with the best intention.  
The two gastro Dr.'s we've been to gave little to no instructions on diet and seemed totally uninterested in anything except viral eradication which turned out to not work for us.  Joe has had a lot of muscle wasting and his last 15 month treatment flop has made this even worse.  He is liking more protein in his diet but he doesn't look good right now and foggy brain symptoms are a problem. The lactulose has to be self monitored because you have to count at least 3 loose stools a day for it to be working properly. The V.A nurse said 3-5.  I don't think Joe is taking enough . He doesn't seem aware of his mental acuity alterations.  They are slight at this point.  He just is having little misjudgments and remembering things incorrectly...nothing dramatic but certainly noticable to me. Interestingly enough, this is one of the first symptoms he was showing 5 yrs ago when he was diagnosed.  It pretty well cleared up after stopping meat.  The Dr.'s don't seem to address encephalopathy until you totally go off the deep end and have to be hospitalized.  I told the nurse practitioner we saw at the time that Joe needed lactulose and she just wrinkled her nose and said, "Eeew! You don't want that stuff.  It's this nasty syrupy goo that makes you poop"   Clearly, she has no clue  how important it is to hold on to your faculties as long as posssible.  How could someone in her position be so ignorant?
Long story short...it looks like protein and lactulose are the way to go.  The VA nurse said to try to give Joe 75 grams a day.  That seems like a lot but I recently noticed that cottage cheese is really high in protein without eating a truckload and Joe likes it.  His appetite isn't always the best.  People with cirrhosis fill up fast.
I apologize for spelling errors.  My spell checker has disappeared from my tool bar for some reason and I don't know how to get it back yet.
Ev

Blessings.  

[tashka]

What if you just eliminate meat, but do not go totally vegetarian? Would he feel OK on such a diet? He would still get some protein, but not too much. Maybe that could be a good compromise?

It is good that lactulose helps, but I think it is just so hard to have loose stools every day. I would prefer any kind of diet to this. Maybe that is why the nurse said that it is a nasty drug. Many patients dislike it and don't want to take it.

[justme53]

That is a switch from the low protein diet and the first I've heard of it too so I can't even give an opinion on it. But I do want to say to go easy on yourself. Things are changing fast and furiously in the HCV treatment field even for late stagers like Joe and me. We pick our way thru the info, consult with the "experts", but eventually we have to make a call based on the info we have at the time and go forth in faith and hope....with perhaps a little fine tweaking down the line. You sound so devoted to Joe's cause from your posts. BTW, cottage cheese is great...it got me thru some serious eating issues a while back. Hope you find a balance that works in keeping Joe healthy and increasing that quality of life factor.

[Rockerforlife]

Get some organic whey and eat some eggs,2 excellent sources of protein.

[Rockerforlife]

Also try 1-2 tablespoons of organic olive oil or coconut oil with the whey and eggs.Better quailty protien than commericial meats.

[Rockerforlife]

almost forgot.... whole wheat veggie pizza is my favourite protien treat.   with lots of pinapples.

[skersj]

I agree with justme. Take it easy on yourself. You did the best you knew to do. That says a lot about you and he is so lucky to have someone like you looking out for him.

[mhudnall]

Hi Ev,

Sorry to hear about Joe's problems.

An old health food substance from decades ago (Dr. Johanna Budwig, Germany) might help. You take one part flax seed oil to two parts cottage cheese and mix it with a hand mixer or blender. You can also add honey to the creamy mixture and put it on berries or other fruit. Very tasty.

The omega fatty acids loosely bind to the sulfuro-amino acids and are good for the liver, are antioxidants, and a source of very good protein.

Hope that helps.

Best regards,

Mike