Re: RDs with Liver disease experience, help appreciated

[Guest guest]

Type 2 or type 1 DM?

How is his HgA1C? Why is he taking metformin together with insulin?

With metformin there is a high chance of vitamin B12 deficiency since it impairs

de production of intrinsic factor.

There is no research on coconut oil in these type of patients, but empirically

speaking it can have advantages.

If he has a bad glucose control I would suggest you try chromium supplements.

LLL courses of ESPEN have alot of info in the metabolic control of these

patients, liver disease and also DM, I suggest you do them. It is free you just

have to register online and they give formation credits.

Catia Borges

>

> Thanks Catia

> Appreciate the insight and your suggestions, which I have basically advised.

>

> I want to have him try coconut oil..(pure source is available to

me)......though don't know if enough research to support it.

> (He is diabetic).

>

>

>

> ________________________________

>

> To: rd-usa

> Sent: Wednesday, May 30, 2012 4:11 AM

> Subject: Re: RDs with Liver disease experience, help appreciated

>

>

>  

>

> Her is a resume of nutritional recommendations, there is alot of papers on it

just do a search on pubmed:

>

> Cirrhosis without encephalopathy:

> - Don't restrict protein (1-1.5g/kg/d)

> -Administration of complex carbs (non refined ones)

> - 30-35 Kcal/kg body weight/day

> - Frequent low volume meals (5-7/day),the night fast shouldn't be over 8h

> - Water restriction if there is hyponatremia

> - Sodium restriciton with ascitis or edemas

> - Polivitaminic supplementation, calcium, zinc, magnesium

>

> Cirrhosis with acute encephalopathy:

> - Transitory restriction of proteins (0.8g/kg/day)for the lowest amount of

time possible

> - Use branched chain aminoacids (fresenius has oral supplements with those)

> - Reindroduce the normal protein ingestion as soon as possible

> - If nutritional support is needed use 35Kcal/day/kg at least

> - Water restriction if there is hyponatremia

> - Sodium restriciton with ascitis or edemas

>

> Cirrhosis with chronic encephalopathy:

> - Moderate protein restricion (0.8-1.0g/kg/day)

> - Oral supplement with branched chain aminoacids

> - Prefer vegetable proteins

> - Frequent low volume meals (5-7/day),the night fast shouldn't be over 8h

> - Water restriction if there is hyponatremia

> - Sodium restriciton with ascitis or edemas

> - Polivitaminic supplementation

>

> Ã " mega-3 might be useful since reduces inflammation and liver fibrosis but

some authors discuss if it wouldn't increase the oxidative stress since

polyunsaturated fats are easily oxidised. Personally I recommend them together

with the ingestion of food high in AO content.

>

> Probiotic agents have been recommend by some authors as well and considering

their modulation of the gut flora and their role in reducing gut bacteria that

produce ammonia, also reduce fibrosis in NAFL I also recommend the use.

>

> On personal experience, and based in some studies done in the decades of

70-80s that never were done again (no idea why because they showed good results)

ketoacids also work very well in patients with chronic and acute encephalopathy

since they bind to the circulating ammonia. Used those in 2 patients that

entered in comma each 2 weeks and they remained stable until the liver

transplant.

>

> On the side note, but this should be for anyone, avoid food with high-fructose

corn syrup added and simple sugars also avoid trans fats.

>

> Any other question feel free to post or mail me.

>

> Catia Borges, nutricionista

> Centro de Saúde Chaves 1

> ARS Norte, Portugal

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