Aa
eggnog yummy
has anyone discovered that eggnog has 18 grams in a cup. Mighty tasty too! quick delicious way to get that fat in the mix.
So I guess the finally take away is eat something solid along with your fat if the fat is in a liquid state? If fat is from eggnog, then eat a slice of bread. Something to make it stick then I take it?
one of the first generation protease inhibitors for HIV was given with cod liver oil in order to increase it's absorption. of course i do not recommend anyone with liver disease take cod liver oil because of the high vitamin A content!
when fats enter the duodenum, the first part of the small intestine, fats are emulsified by bile salts. kind of like when liquid detergent is applied to bacon fat. then the pancreatic enzymes begin to break it down. it would seem to me that a more liquid fat, like milk fat would allow the greatest surface area for the absorption of the teleprevir, big chunks of fat in the stomach and the duodenum, may not offer the large surface area for absorption that smaller particles of fat have. it's just a theory.
eric
eric
This is what Miriam-Webster says the meaning of food is :
Main Entry: food
Pronunciation: \ˈfüd\
Function: noun
Usage: often attributive
Etymology: Middle English fode, from Old English fōda; akin to Old High German fuotar food, fodder, Latin panis bread, pascere to feed
Date: before 12th century
1 a : material consisting essentially of protein, carbohydrate, and fat used in the body of an organism to sustain growth, repair, and vital processes and to furnish energy; also : such food together with supplementary substances (as minerals, vitamins, and condiments) b : inorganic substances absorbed by plants in gaseous form or in water solution
2 : nutriment in solid form
3 : something that nourishes, sustains, or supplies
Main Entry: food
Pronunciation: \ˈfüd\
Function: noun
Usage: often attributive
Etymology: Middle English fode, from Old English fōda; akin to Old High German fuotar food, fodder, Latin panis bread, pascere to feed
Date: before 12th century
1 a : material consisting essentially of protein, carbohydrate, and fat used in the body of an organism to sustain growth, repair, and vital processes and to furnish energy; also : such food together with supplementary substances (as minerals, vitamins, and condiments) b : inorganic substances absorbed by plants in gaseous form or in water solution
2 : nutriment in solid form
3 : something that nourishes, sustains, or supplies
Many people here, on other forums/sites, and in tx all around the country are interpreting the regimen as they see fit. Not wanting to gain weight, being fearful and; unaccustomed to full fat foods, etc all contribute to this self-interpretation of what food is. Yes, for the "healthy, standard, normal human being; liquids could be considered as "food". However, we are all very sick, so sick that unless we cannot stomach real food, and drink is our only rescue option for caliries, nutrients and fats; we must eat. There is a Big difference between eating and drinking. When a full fat meal is suggested, to me and all I have spoken to, sipping or drinking alone, I stress; alone does not qualify as a meal. As I have stated earlier, drink your fat. Have that eggnog; just eat some solid chewable food along with it.
Eggnog is delicious BUT** It is NOT Food!!!!!
CHEW YOUR FATS AND GO OVER. 20g fat if you must.
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As suezeeque pointed out above the real issue is bioavailability of the drug in the body. As long as Incivek is taken with a meal and part of the meal contains 20 grams of fat, whether ice cream, yogurt, egg nog, etc., does it make any difference? Does it really matter if the fat is solid or liquid?
The statement I'm having trouble digesting (pun intended) is understanding why the fats need to be solid and chewed. As long is there is some solid food in the stomach to slow digestion, drinking an eggnog sounds perfectly acceptable. I'm also not sure what you mean by the "strict regime exactly as indicated". Does this also relate to "chewing the fat"? (another pun intended) :o) I'm not challenging your statements, just want further clarification/references for those on INC since consumption of fat is so important. Thx.
CHEW YOUR FATS AND GO OVER. 20g fat if you must.
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As suezeeque pointed out above the real issue is bioavailability of the drug in the body. As long as Incivek is taken with a meal and part of the meal contains 20 grams of fat, whether ice cream, yogurt, egg nog, etc., does it make any difference? Does it really matter if the fat is solid or liquid?
The statement I'm having trouble digesting (pun intended) is understanding why the fats need to be solid and chewed. As long is there is some solid food in the stomach to slow digestion, drinking an eggnog sounds perfectly acceptable. I'm also not sure what you mean by the "strict regime exactly as indicated". Does this also relate to "chewing the fat"? (another pun intended) :o) I'm not challenging your statements, just want further clarification/references for those on INC since consumption of fat is so important. Thx.
Ribavirin is absorbed from the GI tract probably by nucleoside transporters. Absorption is about 45%, and this is modestly increased (to about 75%) by a fatty meal. Once in the plasma, ribavirin is transported through the cell membrane also by nucleoside transporters.
Ribavirin is widely distributed in all tissues, including the CSF and brain. The pharmacokinetics of ribavirin is dominated by trapping of the phosphate form inside cells, particularly red blood cells (RBCs) which lack the enzyme to remove the phosphate once it has been added by kinases, and therefore attain high concentrations of the drug. Most of the kinase activity which converts the drug to active nucleotide form, is provided by adenine kinase. This enzyme is more active in virally infected cells.
The volume of distribution of ribavirin is large (2000 L/kg) and the length of time the drug is trapped varies greatly from tissue to tissue. The mean half-life for multiple doses in the body is about 12 days, but very long-term kinetics are dominated by the kinetics of RBCs (half-life 40 days). RBCs store ribavirin for the lifetime of the cells, releasing it into the body's systems when old cells are degraded in the spleen.
About a third of absorbed ribavirin is excreted into the urine unchanged, and the rest is excreted into urine as the de-ribosylated base 1,2,4-triazole 3-carboxamide, and the hydrolysis product of this, 1,2,4-triazole 3-carboxylic acid.
With Incivek, similar info has been documented in their insert and it is strongly suggested to adhere to a strict regimen exactly as indicated
For me, I am going along with what the companies have instructed.
I had a conversation with a RN at Genentech(pegysys) last nite and she mentioned to me that the water consumption info has been changed. It is now straight acrossthe board 8-10 8 oz glasses of water per 24 hr period. They had found people in SOC and triple tx were drinking not enough or too much water depending on weight (50% body weight vs oz water). In drinking too much water, although hydrating, our electrolytes are being flushed out unknowingly.
I am confirming this w my physician tomorrow. Thought y'all might be interested in that ditty.
P
Ribavirin is widely distributed in all tissues, including the CSF and brain. The pharmacokinetics of ribavirin is dominated by trapping of the phosphate form inside cells, particularly red blood cells (RBCs) which lack the enzyme to remove the phosphate once it has been added by kinases, and therefore attain high concentrations of the drug. Most of the kinase activity which converts the drug to active nucleotide form, is provided by adenine kinase. This enzyme is more active in virally infected cells.
The volume of distribution of ribavirin is large (2000 L/kg) and the length of time the drug is trapped varies greatly from tissue to tissue. The mean half-life for multiple doses in the body is about 12 days, but very long-term kinetics are dominated by the kinetics of RBCs (half-life 40 days). RBCs store ribavirin for the lifetime of the cells, releasing it into the body's systems when old cells are degraded in the spleen.
About a third of absorbed ribavirin is excreted into the urine unchanged, and the rest is excreted into urine as the de-ribosylated base 1,2,4-triazole 3-carboxamide, and the hydrolysis product of this, 1,2,4-triazole 3-carboxylic acid.
With Incivek, similar info has been documented in their insert and it is strongly suggested to adhere to a strict regimen exactly as indicated
For me, I am going along with what the companies have instructed.
I had a conversation with a RN at Genentech(pegysys) last nite and she mentioned to me that the water consumption info has been changed. It is now straight acrossthe board 8-10 8 oz glasses of water per 24 hr period. They had found people in SOC and triple tx were drinking not enough or too much water depending on weight (50% body weight vs oz water). In drinking too much water, although hydrating, our electrolytes are being flushed out unknowingly.
I am confirming this w my physician tomorrow. Thought y'all might be interested in that ditty.
P
I'm not taking this drug so I have no clue... But just reading the above leads me to believe that the addition of fat relates to bioavailability of the drug in your body. Nothing to do with how fast or slow it takes to move through your stomach and intestines. :)
I do agree with Lifenet62 about the pills absorbing more slowly if there are some solids. That is why I was eating a large slice of bread with a lot of butter on it along with a huge portion of Greek yogurt (for my morning snack).
I think if we think about it, any pills we put into our mouths (tylenol,, benadryl, loperimide, any pill) does absorb faster if taken on an empty stomach. I can tell it does because a tylenol will work faster if I take it by itself and not with food or after a meal. Even alcohol should always be taken with food to slow down the absorption rate. I don't think milk or eggnog would slow the absorption of alcohol very much but a meal, even a light meal, would. So to me, it just makes sense that the Incivek would also absorb slower if taken with solid food, at least some of it solid, along with the high fat part. It takes food a lot longer to go through the system than it takes liquids to go through the system.
I don't want to take the chance so I will eat some solids along with anything else I eat/drink.
I think if we think about it, any pills we put into our mouths (tylenol,, benadryl, loperimide, any pill) does absorb faster if taken on an empty stomach. I can tell it does because a tylenol will work faster if I take it by itself and not with food or after a meal. Even alcohol should always be taken with food to slow down the absorption rate. I don't think milk or eggnog would slow the absorption of alcohol very much but a meal, even a light meal, would. So to me, it just makes sense that the Incivek would also absorb slower if taken with solid food, at least some of it solid, along with the high fat part. It takes food a lot longer to go through the system than it takes liquids to go through the system.
I don't want to take the chance so I will eat some solids along with anything else I eat/drink.
Following is the Incivek insert information referenced. Although it mentions food, it doesn't specify whether the food needs to be in solid, semi-solid or liquid form. I think this is the issue and would like to hear if anyone can clarify. As soon as ice cream goes down the throat, it melts very quickly, so no longer frozen.
It may be healthier for our diet to eat more solid foods, but when it comes to Incivek absorption, I don't understand why it would make much difference as long as you got your 20 gm of fat. If there's something that I missed in this insert which would help to clarify, please point it out. It is interesting reading and thanks for posting.
Effects of Food on Oral Absorption
The systemic exposure (AUC) to telaprevir was increased by 237% when telaprevir was administered with a standard fat meal (containing 533 kcal and 21 g (fat) compared to when telaprevir was administered under fasting conditions. In addition, the type of meal significantly affects exposure to telaprevir.
Relative to fasting, when telaprevir was administered with a low-fat meal (249 kcal, 3.6 g fat) and a high-fat meal (928 kcal, 56 g fat), the systemic exposure (AUC) to telaprevir was increased by approximately 117% and 330%, respectively. Doses of INCIVEK were administered within 30 minutes of completing a meal or snack containing approximately 20 grams of fat in the Phase 3 trials. Therefore, INCIVEK should always be taken with food (not low fat).
It may be healthier for our diet to eat more solid foods, but when it comes to Incivek absorption, I don't understand why it would make much difference as long as you got your 20 gm of fat. If there's something that I missed in this insert which would help to clarify, please point it out. It is interesting reading and thanks for posting.
Effects of Food on Oral Absorption
The systemic exposure (AUC) to telaprevir was increased by 237% when telaprevir was administered with a standard fat meal (containing 533 kcal and 21 g (fat) compared to when telaprevir was administered under fasting conditions. In addition, the type of meal significantly affects exposure to telaprevir.
Relative to fasting, when telaprevir was administered with a low-fat meal (249 kcal, 3.6 g fat) and a high-fat meal (928 kcal, 56 g fat), the systemic exposure (AUC) to telaprevir was increased by approximately 117% and 330%, respectively. Doses of INCIVEK were administered within 30 minutes of completing a meal or snack containing approximately 20 grams of fat in the Phase 3 trials. Therefore, INCIVEK should always be taken with food (not low fat).
I've been eating yogurt, which I've been able to get down -- it's not exactly a chewable fat, tho, is it?
So, I'm confused: ice cream, yes; yogurt, yes; eggnog only, no?
So, I'm confused: ice cream, yes; yogurt, yes; eggnog only, no?
Here's what they also say about absorption etc: pi.vrtx.com/files/uspi_telaprevir.pdf
This is the insert included with our Incivek.
Page 10, Pharmacokinetics. Read Absorption, effects, distribution, metabolism and elimination. Good stuff.
This is the insert included with our Incivek.
Page 10, Pharmacokinetics. Read Absorption, effects, distribution, metabolism and elimination. Good stuff.
Ice cream is fine. It is frozen. It digests differently because it has to be eaten not drank.
Ice cream IS suggested and refered to in the spiralbound book treatment reference guide included w your timer and journal log book. Page 9 clearly states Always take Incivek with food. They only show examples of foods. Liquids allow for an empty stomach not suitable for digestion of such strong meds.
Olive oil is fine, the many different oils used in cooking are how we get most of our fats from
foods. When using the olive oil eat something with it as substance.
Snaks are good as well. I do avoid hard nuts and do nut butters instead tho, for the ease of occassional bowel anal issues
Ice cream IS suggested and refered to in the spiralbound book treatment reference guide included w your timer and journal log book. Page 9 clearly states Always take Incivek with food. They only show examples of foods. Liquids allow for an empty stomach not suitable for digestion of such strong meds.
Olive oil is fine, the many different oils used in cooking are how we get most of our fats from
foods. When using the olive oil eat something with it as substance.
Snaks are good as well. I do avoid hard nuts and do nut butters instead tho, for the ease of occassional bowel anal issues
Ice cream was definitely on the recommended list for high fat foods with Incivek, although I have had to look for sugar free ice cream because of my husband's high blood sugar. Peanut butter, cream cheese, potato chips, cheese, nuts, and avocados are all high fat foods that he has tried. He's pretty sick of all of them (just starting week 6 of triple tx), and thought egg nog sounded pretty appealing. Keep us posted as to what you find out about liquid vs. chewable food for the fat intake.
Advocate 1955
Advocate 1955
Okay, just got off the phone with the Incivek 24/7 nurse line (855) 546-2483. Ice cream is on the list of recommended fats from the manufacture. I think I'm going to continue to hang out with my friends Ben & Jerry.
I will work in some others fats too since my appetite is starting to come back. Isn't this a common misconception with milk that it is quickly absorbed and that's how "milk chugging" holding down a gallon a milk chugged in an hour was born on college campuses? You can't keep it down because the proteins in the milk don't allow for quick absorption so people begin to "lose it" vomit because it can't be digested that fast.
Yum eggnog - it's on!!!
I will work in some others fats too since my appetite is starting to come back. Isn't this a common misconception with milk that it is quickly absorbed and that's how "milk chugging" holding down a gallon a milk chugged in an hour was born on college campuses? You can't keep it down because the proteins in the milk don't allow for quick absorption so people begin to "lose it" vomit because it can't be digested that fast.
Yum eggnog - it's on!!!
I've been eating a lot of Greek yogurt with my meds, but I do usually eat a slice of bread with butter on it at the same time. I wonder if we ate something solid, even if it is not high fat, and also drank a cup of eggnog and then took our meds. That would take care of the solids and also the fat.
When I spoke to the Vertex people, they said it did not matter how you got the 20 grams of fat. If you were having a hard time swallowing the nurse said you could take 2 tablespoons of olive oil.
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