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374652 tn?1494815035

anti fibrotic diet info

I hope someone can link me to information on the anti fibrotic diet, supplements etc.
Thank you, M4now  
9 Responses
Avatar universal
Hey, I did some cutting and pasting and put this together. It may not be complete but I hope it helps-------A prebiotic is a substance that will selectively foster/enhance/give a growth advantage to those bacteria in the intestinal mix that do not produce ammonia amd other toxins, but rather live of the offered prebiotics - mostly undigestable carbohydrates- and produce actually substances, like certain fatty acids that nourish the intestinal epithelial cells/ improving the intactness/functionality of that critical layer.. You could call them the good cows of the intestines.

Examples of excellent prebiotics are inulin ( a branched chain fructooligosacharide), FOS ( FructoOligoSacharide - not branched), and Lactulose, a monosugar that cannot be absorbed by the human intestinal tract and therefore provides food for the good bacteria.

You want as many of those as possible, because they push back/reduce the negative/unfriendly toxin and LPS producing bacteria, that can cause damage to the intestinal lining ("leaky gut syndrome"), can be flushed up to the liver themselves or their proinflammatory breakdown products can reach the liver eg LPS =Lipopolysacharide= extremely proinflammatory cell wall substance.

Furthermore any undigested protein/amino acids will foster these toxic bacteria that produce harmful metabolites like ammonia, but also a host of other problematic substances ( eg benzodiazepin-valium-like substances), which, if the liver is not capable of detoxification due to a reduced liver mass and processing capacity, can reach the general circulation and in particular the brain, often causing, even in compensated cirrhosis, a syndrome called subclinical encephalopathy, that can - and has been convincingly- shown by psychometric tests.

The effect of these toxic bacteria on the liver itself is enhanced inflammation and enhanced fibrosis.Thats why this is an integral part of an antifibrotic regimen, an important aspect of the "do the least harm to the liver" strategy.

A probiotic is actually a preparation of "good bacteria" itself, not the food for the cows, but the cows themselves, so as to constantly reseed the intestines with a positive population. it is important to understand that there is easily a pound of bacteria or more present in the intestines, therefore a 400mg "probiotic" capsule will not quickly make a big difference.

There are many offerings of "probiotic bacteria" by the supplement industry, they are difficult to judge. In this situation those where university or governmental funded research has provided useful publications to support them could be selected. In that sense Lactobacillus GG has been well researched.
Since those are real live organisms, they need to be treated with care until use and the quality in their production seems important. As such products that are individually sealed in aluminum blister packages and are stored in the refrigerator until use probably deserve more confidence. If the bacteria that you swallow are dead, they are useless.

It is very difficult to say, how many probiotics are needed once a prebiotic is used anyway. It might or might not be overkill to swallow a prebiotic every day, once you are eg already using inulin.
But if someone can afford it, the extra safety margin from a combo of these measures might be worth it.

Yoghurt is in principal a probiotic, containing some life bacteria. But in a situation of liver disease/fiibrosis its effects are likely way too weak.
Therefore always this is the hirarchy ( organized by priority) of the approach:

Eating patterns - liver metabolic stress reduction. Many small meals each with fiber embedded slow resorption carbs+30% lean protein+ only healthy fats/oils

Intrestinal health- eubiosis - Glutamine(integrity of intestinal epithelium),prebiotic ( Inulin, Lactulose), Probiotic ( Lactobacillus GG)

Supplements - :
Supporting specific aspects of liver metabolic burden - like TMg, SAMe

Thiol containing compounds: NAC (always with equal mg Vit C),, ALA, Taurine : Build fundamental hepatic/bodywide Glutathione reserve, protect from ox stress toxicities ( like Tylenol)
They also help to block the ox stress dependent stellate cell(fibrogenesis) activation pathways.
Many more functions of course not mentioned here.

PPC: membrane fluidity and functionality

Inhibiting the activation of stellate cells into fiber producing myofibroblasts:

Resveratrol: inhibits with high efficacy Tumor Growth factor beta - the key player in the activation of fibrogenesis in the liver ( is key activator of improper "wound healing", scar formation (fostering the production of collagen fibvers from transformed stallate cells) inside a parenchymal organ- the liver)

Curcumin : Most effective in blocking the activation of NFKappaB, a nuclear activator of proinflammatory gene expression and also extremely involved in the formation of fiber forming cells in the liver from stellate cells)

Green tea extracts : Same as Curcumin, with less NFKB deactivating capacity, but likely other
complex antiinflammatory benefits.

HR recommends Lactobacillus GG taken concurrently with Alinia. Alinia will wipe your intestinal bacteria and the probiotic will replace it.

Overall several key pathways leading to activation of fibrosis will be blocked/reduced in their activity, which will build to a synergistic effect over time. Each of these individual measures has decent research backup, while all are considered GRAS, but no direct comparison has ever been made so it is hard to estimate the relative contribution.

Veggies and salads are the "macrofibers+ microfibers ". They slow everything down, even the basic enzymatic digestion process : macromolecules in food to absorbable monomers of sugar, amino acids and fatty acids. . . Grains - simultaneously with the above therefore, never as a "bolus' as such by themselves , grains should ideally be mainly oatmeal, little to no wheat and always in moderation. Veggies and salads themselves have slow carbs right in them. What matters is the slow offering of the enterically absorbed "nutrients" to the liver, that has to work them up as they come and therefore can be easily overwhelmed=damaged. if the offerings exceed the available capacity for "nonstressful processing". It is mainly a biochemical processing plant and it can only do so much per minute....Fruits/berries should also be embedded if possible, since they often . contain relative high available monosugar amounts..It is obvious that any true "sugar" containing drinks or even fruit juices are problematic for all these reasons and "deserts" are not even discussed.....

If you take lactulose prophylactically, then the ammonia producing bacteria will be kept at a low level and the lactulose dose to achieve this will be low, with no unpleasant degree of diarrhea. If a patient has already toxic CNS symptoms, the presribed dose of course will be high and diarrhea will be intense. Again, hepatic encephalopathy can be life threatening and then even lactulose enemas are given to save the patient.

Because of this almost miraculous effect of lactulose, it seemingly is respectfully considered a "drug" here - and by some doctors-, something to be reserved for severely ill patients.

In reality it is a harmless sugar, simply fostering a nontoxic enteric flora that lives on lactulose that we cannot absorb, reducing not just ammonia but also LPS and endotoxins reaching the liver from the gut, reducing hepatic and overall inflammation, having antifibrotic effects for that reason and preventing "bacterial translocation" that is the transport of bacteria from the gut lumen through "leaks' in the guts epithelial lining into the intstinal tissue towards local lymphnodes and the liver. It preserves the integrity of the intestinal mucosa, which further reduces the antigen induced stress on the liver, calming
Avatar universal
the Kupfer cells, which are sitting there to catch these foreign intrusions that all hit the liver first.

It is therefore, together with some probiotic bacteria, part of any reasonable probiotic/eubiotic treatment plan of the intestinal flora, with great importance to anyone with liver disease and and eye towards reducing hepatic and systemic inflammation, fibrosis progression /regression.

It is something that, in low dose, even a "healthy" person should consider as part of his/her lifestyle.

Here is a study to determine its "toxicity":

Lactulose has profound health benefits by way of increasing bifidobacterial flora in the intestine of infants thereby protecting them against enteric infection, constipation and systemic encephalopathy. In the present study to assess the sub chronic toxicity of lactulose syrup, the rats were fed on a basal feed supplemented with lactulose syrup at 0.5, 1.0, 2.0 and 5.0% for a period of 21 weeks. Monitoring of food consumption, gain in body weight and physical observations did not reveal any treatment-related toxicity in any of the group of rats. Terminal autopsy also did not reveal any signs of toxicity. Further, no significant alterations in relative organ weight, serum biochemistry and urinalysis were observed up to 1% lactulose supplementation level. The results suggest that supplementation of lactulose in the diet does not produce any toxicity at the doses tested.

Supplements as of 1/1/08 I have added links if additional info wanted.
a multi vitamin/no iron
1000 mg of Salmon Oil (epa=160 mg / dha=240 mg / omega 3 = 400 mg) x1

1000 mg of Flaxseed Oil (ALA/omega 3 450 mg / omega 9 110 mg) x1

Raw flaxseed/ 1 teaspoon daily

Hepatapro PPC (polyunsaturated  phosphatidylcholine 900 mg) x 2
info: http://www.medhelp.org/posts/show/346752

Resveratrol (500 mg) x1 and x2 (alternate every other day)                                            info: http://www.lef.org/resveratrol/ source: http://megaresveratrol.com/

NAC--(n-acetyl-l-cysteine) A sulfur compound that is a precursor of glutathione and protected sulfur-containing amino acid (600 mg) x2 with Vit C (500 mg) x2               Info: http://tinyurl.com/9yopf

TMG (trimethylglycine) (750 mg) x 2

Taurine (500 mg) x 2

Life Extension Super Curcumin W/Bioperine 800Mg 60 Caps (800 mg) x 2 / Powerful Antioxidant Properties to scavenge free radicals Anti-Inflammatory Actions Enhances important detoxification enzymes Curcumin increases the secretion of bile by stimulating the bile duct. It also protects the liver by detoxification, stimulating the gall bladder and scavenging free radicals. With the help of the adrenal glands, it inhibits both platelet aggregation and the enzymes which induce inflammatory prostaglandins. Curcumin may also help break down fats and reduce cholesterol. Large doses not recommended in cases of acute bilious colic, obstructive jaundice, painful gallstones, and extremely toxic liver disorders

Sylmarin (360 mg) x 3 / Milk thistle provides hepatocellular protection by stabilizing hepatic cell membranes.

Green Tea Extract (300 mg) x 2        
/ info: http://tinyurl.com/ypdp9q

Coq10 (200 mg) x 1    
info    / http://tinyurl.com/29em8c

Avatar universal
This info is not put together, just cut and pasted. Hope you can work your way thru it. later, jerry---------Colon complete complex contains: Fiber complex (2000 mg) x2 Lactobacillus F19 probiotic (14 mg) x 2 Lactospore prebiotic (20 mg) x2 I use Smartbomb.com as a source except for the Resveratrol. I will go with Lactulose amd Lactobacillus GG when I use up what I have. ------------------------------------------------------------------------------------ What to take while on tox per HR The supplements while on tx question is difficult, because the ones having antifibrotic promise are almost all antiinflammatory, somewhat reducing the initiating events at the dendritic cell/lymphocyte interface.I know this sounds technical. Most of them also have, paradoxically an improving effect on some aspects of lymphocyte function, as the spectracell test clearly shows. Bottom line, NO CLEAR ANSWER possible regarding use during tx. But a moderate use of NAC/VitC, TMG, ALA ( those are quite cheap and possibly PPC (since it was actually shown to help the SVR rate) is probably a good idea even during tx. Vit D3 is good, but it would be best to know ones serum level. Also some Inulin is inexpensive (trader joes) and a very good well researched prebiotic. To get any lactulose here in the US is not trivial.

Hepatogastroenterology. 1998 May-Jun;45(21):797-804.

Polyunsaturated phosphatidyl-choline and interferon alpha for treatment of
chronic hepatitis B and C: a multi-center, randomized, double-blind,
placebo-controlled trial. Leich Study Group.

Niederau C, Strohmeyer G, Heintges T, Peter K, Göpfert E.

Department of Medicine, Heinrich-Heine-University of Düsseldorf, Germany.

BACKGROUND/AIMS: Polyunsaturated phospatidyl-choline (PPC) has been shown to
reduce serum aminotransferases in experimental hepatitis. This multi-center,
randomized, double-blind, placebo-controlled trial evaluated the effects of PPC
in patients with chronic hepatitis B and C in combination with interferon alpha
2a or 2b. The diagnosis of chronic viral hepatitis was based on an abnormal serum
alanine aminotransferase (ALT) value (more than twice the upper value of normal),
viral replication and chronic hepatitis found on liver biopsy. METHODOLOGY:
Patients received 5 million I.U. (Hepatitis B) and 3 million I.U. (hepatitis C)
interferon s.c. thrice weekly for 24 weeks, respectively, and were randomly
assigned to additional oral medication with either 6 capsules of PPC (total daily
dose: 1.8 g) or 6 capsules of placebo per day for 24 weeks. Biochemical response
to therapy was defined as a reduction of ALT by more than 50% of pre-treatment
values. The responders were treated for further 24 weeks after cessation of
interferon therapy with either PPC or placebo. RESULTS: 176 patients completed
the study protocol (per-protocol population: 92 in the PPC and 84 in the placebo
group). A biochemical response (> 50% ALT reduction) was seen in 71% of patients
who were treated with PPC, but only in 56% of patients who received placebo (p <
0.05). PPC increased the response rate in particular in patients with hepatitis
C: 71% of those patients responded in the PPC group versus 51% in the placebo
In contrast, PPC did not alter the biochemical response to interferon in patients
with hepatitis B. PPC did not accelerate elimination of HBV-DNA, HBeAg and
HCV-RNA. CONCLUSIONS: In conclusion, PPC may be recommended in patients with
chronic hepatitis C in combination with interferon and after termination of
interferon in order to reduce the high relapse rate. PPC may not be recommended
for patients with chronic hepatitis B. In contrast to IFN and other antiviral
agents PPC does not carry major risks and is tolerated very well.

Inulin and lactulose will beneficially grow/foster slightly different strains of beneficial/nontoxic/noninflammatory/intestinal epithelia feeding(yes!) bactreria that will together more efficiently push back the dangerous ammonia/slew of other toxins producing/proinflammatory harmful bacteria to small numbers by competing for available space and by the production of natural local antibiotic factors that reduce the growth potential of the more pathogenic species.

The importance of blocking/reducing proinflammatory signals and toxins to the liver in a condition of compromised liver function and an already inflammatory state in the liver cannot be overstated.

Similarily the related concept of reduction of "leaky gut syndrome"/ amount of residual epithelial leakage due to compromised intestinal endothelial function to a minimum by "eubiosis" is of paramount importance.
A teaspoon of Glutamine/day is also further important in that context, since the rapidly dividing intestinal epithelial cells require this particular amino acid in particular high amounts.

374652 tn?1494815035
OK, looks like I've got alot of digesting to do.. Thx.....M4now
That is a tremendous effort on your part and I appreciate it.
374652 tn?1494815035
I want to direct my thanks to you orleans
144210 tn?1273092382
All looks pretty familiar to me.lol  Good job.
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