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British Liver Trust
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Diet for hepatic Encephalopathy

I have mild HE and have read that eating red meat produces toxins that go to the brain. I am taking Rifaximin and Lactulose and have not eaten lamb, beef or pork since. I do find it difficult to find proteins as I am also allergic to fish and have coeliac disease. I have chicken,cheese and eggs but have already lost a lot of muscle.

If you have HE what have you been told about red meat? I would be very pleased for advice. Thank you

Koinonia

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Dear Koinonia

Thank you for joining our forum. We hope you find it helplful and supportive.

We have information on Hepatitic Encephalopathy (including a publication you can download) on our website which you might find helpful:

britishlivertrust.org.uk/li...

I hope this helps.

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Thanks for the link, Trust2! One particular statement leaped out at me: "Patients with severe repeated cases of HE may be advised to reduce the amount of protein in their diet but it is important that this is only done on medical advice as a lack of protein can cause malnutrition." In January and February, 2018, I spent a total of 6+ weeks in a hospital, then in a "skilled nursing" facility (HA! They almost killed me.), then back to a hospital (related to the first, but bigger), then to an "acute care" facility (another near death experience). I was suffering from malnutrition, among other conditions. Most of the time I was drinking protein drinks, and still am. My PCP and GI doctor both know I'm taking in at least 60g of protein/day, as the recommended dose is one gram for each kilogram of weight. I may eat red meat or pork once a year at most, and, yes, I find that both take longer to digest than other foods. I do eat chicken and fish and eggs and milk products (CHEESE is my favorite food group).

My PCP is trying to increase my "prealbumin" level, which started at 4, slowly moved up to 6, and now is at 8 -- still well below the "normal" level of 15-36 mg/dL. According to information from BLT (bacon, lettuce and tomato? ;-) ) I suppose this means I'm still malnourished. I was aware of having HE when I was hospitalized -- looney tunes! Now I just have episodes of dizziness, and sometimes I almost fall asleep while standing up. Like today: I ran into a door and badly bruised my arm; then fell asleep twice (once for 3 hours; later, for another 3 hours).

I know you will recommend that I speak with my PCP. I shall, but in the US we have to pay for medical care, so I try to limit visits, even though Medicare (for those over 65, or on disability) pays for 80%, sometimes more. I'm just wondering if anyone else has had these symptoms during an episode of HE.

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Good morning,

The HE publication is in the process of being updated. The new version has removed the sentence which mentions possible reduction in protein intake for HE. You clearly understand the importance of protein in liver disease - we hope you can get clarification from your medical team/dietician.

best wishes

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Hi koinonia .I too have mild HE , but finding that it is becoming slightly increased. I was only ever told by my hepetologist to have high protein low salt and that was the same with I was diagnosed with cirrhosis in 2008 . I don't ever eat red meat as I am not a lover of it. I'm on lactulose, have been since May. I am due to see my dr Wednesday as results are back from 3rd dexa scan which shows increased thinning in my left hip due to the pain I get now when walking. Hope the link was useful to you above.

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Hi

Sorry to interrupt but what are the symptoms of mild he please? I think I might have it but not sure xxxx

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Hi lynn; how are you ? My symptoms are a mixture. I get either very lethargic, worse thing of all is my insomnia and disruption to everyday things as I can easily sleep in the day at any time. I do get confused now and then and my memory isn't what it used to be. I find my concentration has changed and don't have the patience to read for too long either. Very frustrating.. I have also noticed in the last two weeks my anxiety has returned? But going to see my dr .I am on lactulose but I find it way too sweet and upsets my tummy xxx

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Thank you so much, that has really helped I do seem to have a lot of the symptoms. I will go to my Dr

I hope you go on ok at the drs. Thanks once again. Please take care . Lots of love Lynne xxxx

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Your welcome Lynne. I did not even know I had any symptoms untill I put two and two together so to speak, plus it was my sister who picked up on my memory. Hope all goes well .xoxox

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Thank you. Hope you feel better soon xxxx

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I was never told to avoid red meat when I suffered with H.E and believe me mine was not mild. You can't afford to lose muscle as you really do need it and for yours to be going means your liver and body is feeding off it. If your consultant or dietician hasn't told you to avoid red meats then don't. When in doubt always ask the professionals, people on here don't always recommend the correct course of action and what works for one doesn't work for another. And avoiding red meat isn't doing you any favours but check as well.

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I think the only reason some people say don't eat red meat is it is harder to digest , therefore may stay in the gut for longer , which may add to higher levels of toxicity . You can increase your protein throug other ways , nuts are great , a few every couple of hours, you can use whey or pea protein powders. . If you find nuts ghardhad to chew. Grind them , and they add a great dimension to salads, yogurts , desserts and smoothies. They also contain a variety of vitamins, minerals and amino acids . I don't eat red meat , but have not done so for 40 years as a life style choice.

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My husband suffers with odd bouts of HE, but was never told to avoid red meat as he was instructed by his dietician to eat high carb, fat & protein diet to feed his liver, so his liver doesn't feed off him & his muscle mass. He has lactulose to take when needed such as of he hasn't had a bowel movement or feels confused to start grabbing the toxins in his blood. We were also told that permanently being on lactulose can cause episodes of HE as it can lead to dehydration. However saying that every case is different

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My husband has Hepatic Encephalopathy...he was diagnosed this year...because he is at the overt stage. There is never a time when you have odd bouts...its there and doesnt go away. The brain has been damaged by toxins because the liver is not working correctly by not eliminating the ammonia produced by animal proteins.

As for the diet...its important to eat protein in your diet, the body needs it. Animal protein in small amounts is quite safe..40-50 grams a day...It was noted by the medical teams that animal protein should be avoided, because of it exacerbating the condition of HE, but they now recommend its fine.Eating a regular diet,that is varied is vital to healthy living otherwise, you can become malnourished.

Lactulose is needed to assist with eliminating the toxins from the body.

Its imperative that you visit a gastroenterologist consultant and be under the expertise of a specialist. Like you say every medical case is individual.

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I HAVE LATE STAGE CIRRHOSIS AND FIBROSIS FROM HEP C FOR 30 YEARS THAT WAS FINALLYCURED BUT NOT QUITE SOON ENOUGH. I BEGAN TO NOTICE THAT AFTER I ATE BEEF I WAS GETTING REALLY SICK AND HAVING RAGE EPISODES. BUT HAM AND BACON HAVE NOT BOTHERED ME AT ALL SO PORK IS THE OTHER WHITE MEAT. IF YOU'RE LIKE ME AND LOVE HAM AND BACON GO AHEAD!!! IT'S SAFE AND CAUSES NO SIDE EFFECTS. ALSO CRANBERRY IS AN ESSENTIAL FOR ANTINFLAMITORY ANS ANTIOXIDENTS!!! SO HAM AND CRANBERRY OR CHICKEN OR TURKEY ARE ALL GOOD FOR YOU AND WILL HELP SO MUCH!!

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Thank you all so much for sharing your personal experiences. I am now eating pork which my GP said was OK in small doses and occasional slice of ham as well as chicken,cheese,eggs and nuts etc Part of the reason my muscles are wasting is because I went through a period of about 2 months when I always felt full and didn't want to eat anything!!! I am now getting back to normal!!!!!! The cranberry sounds a good idea too.

Once again thank you all and best wishes for your future

PS Thank you BLT for your post, I already have the HE book,

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I have a problem with feeling full very often and mine is caused by my stomach filling up with blood from ulcers and varicosities caused by my liver disease. If you ever have black or very dark stools or it looks like coffee grounds, you should contact your doctor immediately.

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I do love me some ham!

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