I’ve not posted anything for a while due to ill health, so here is hopefully some “food for thought”. This is for information only.
For a while now, I have been concerned about the lack of understanding of some healthcare professionals when it comes to Hepatic Encephalopathy.
My personal experience was typical of many people. I suffered from episodes of frustration, forgetfulness, confusion, irritability and the inability to concentrate on more than one thing at a time.
When I first reported my HE symptoms to my then GP. She just prescribed Lactulose as being the correct course of treatment. She didn’t even record my condition on my medical file. My condition deteriorated and was finally diagnosed some 15-months later while on a routine visit to the QE.
The name “Hepatic Encephalopathy” basically means brain damage or disease caused by the liver. So, this falls under the remit of the Gastroenterologist, or Hepatologist as the liver seems to be the cause of the damage. However, little or nothing seems to be done about the damage already caused to the brain, as this should now be a neurological condition.
In my opinion, many GPs don’t seem to fully appreciate the severity of HE.
I am now six years post-transplant and still seem to suffer from certain symptoms of HE. So, what is going on?
I am now becoming convinced that HE has far more long term serious consequences for some people. I have come across a condition called “Alzheimer’s Type II astrocytes”: pubmed.ncbi.nlm.nih.gov/330...
There is a rather nice video that explains how changes in the brain can bring about Alzheimer’s. Here I believe that damage to the Astrocytes and Microglia cells caused by ammonia can bring about the build-up of Tau within the brain as this video illustrates: youtu.be/0GXv3mHs9AU
“Alzheimer’s Type II astrocytes” should not be confused with Alzheimer’s Disease, however, these two versions do have certain similarities.
I now believe that HE can cause certain long term brain damage which could be better treated if it was diagnosed as being “Alzheimer’s”. There appears to be very little research into this going on here in the UK. I certainly would like to take part in any possible research trials into “Alzheimer’s Type II astrocytes”.
This is a very heavy subject, and research is still very much ongoing, but I just wish there was greater importance placed on those people who suffer from HE.
Treat the brain as well as the liver.
Richard
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Richard-Allen
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Thank you, Richard. It does seem like like there isn’t much research or education on hepatic encephalopathy and the stigma that surrounds it even if one is now a nondrinker
Extremely thought provoking. Just been discussing with my son who is doing a PhD at UCL , his majn interest being neurological and behavioural effects of hallucinogens. There are some interesting projects and results surrounding alcoholics and their brain chemistry but you are more than right, we don't really know squat about what our brains are doing
Thank you for sharing this Richard. I’m also going to flag it to someone doing a PhD. Probably not their field but I know they do brain scans. I figure the more people in the scientific community who are aware the greater the chance of research.
I really feel for those affected by HE - I should have had it severely but thankfully have not experienced it. I know I haven’t as my job requires me to be in the top 1% of mental performers - to say developing it terrifies me is an understatement. For those who have had gradually creep up, what was the “sign” if anything?
Hello LaLola, sit down and have a cup of coffee, this is going to be a long reply. You may think I've gone off target here, but please bear with me.
This is a tricky question to answer. Personally, I wouldn’t eat these snacks late at night. It depends upon the person, and I’m not really medically qualified to advise you on this.
What might be good for some people, could be harmful to others? So always seek advice from your doctor or healthcare provider. That having been said, the liver is the body's sugar factory. Everything that enters the mouth, or is rubbed into the skin, will find its way to the liver eventually.
Sugars are broken down in the liver and turned into glucose, which in turn is turned into carbohydrates and stored as fat for later use.
During the day, our livers are carrying out over 500 different functions. Cleaning the blood and filtering out any harmful chemicals etc. There are over 650 muscles in our bodies and around 4000 tendons these all need a supply of glucose to burn so they can work.
In our bodies, there is a gene called the CRTC2 gene. This gene is located in several different places, the brain, the spine, the liver and even the placenta. This gene is sometimes called “The Switch Gene”. I like to picture this as being like a three positioned switch. In position 1. This gene goes about monitoring the amount of glucose in the blood at any one time.
If all of a sudden we need more energy like running to catch a bus, this gene switches to position 2. Here a message is sent out to the liver to start dumping more sugar (glucose) into the bloodstream so the muscles have more fuel to burn.
Once we’ve caught the bus and sat down, the switch gene goes back to position 1. And a signal is sent out from the pancreas to send out insulin. It is believed that insulin is the signal that tells the liver to stop dumping glucose. In some people with severe liver cirrhosis.
Because of all the scar tissue, this insulin message can’t get through. This means that the person has now become insulin resistant. The liver continues to dump sugars. The person has now become a type 2 diabetic: salk.edu/news-release/sugar...
Now the magical part happens.
During the day our bodies are burning off glucose sent out from our liver. When we go to sleep and enter into deep REM sleep, the CRTC2 gene moves into position 3. This causes all those muscles in the body that are still working, to start to burn fat instead of glucose. You are now burning fat while you sleep.
So, in the case of that high carbohydrate/protein bar, the nutrients will be broken down in the stomach and passed onto the liver. So, you are only replacing the carbs that the body is trying to burning off while you sleep.
Personally, I wouldn’t have a high protein bar at night and allow the body to do its own thing.
Hi LaLola77, your profile doesn't make it clear what your diagnosis is - if it's fatty liver rather than full on cirrhosis then the carbohydrate before bed may not apply. The carbs and protein diet tends to be when your body is in a state of advanced cirrhosis when your liver will start robbing your muscles for fuel rather than burning fat.
As with all issues liver related it is best to try and get individualized dietary advice from a specialist dietician who has all your medical details to hand.
Stuffing loads of carbs may not be necessary in your case. My hubby though had to follow the high carb, high protein diet with a large carb rich supper as he was malnourished, skeletal and preparing for transplant and his muscles had all wasted away. The liver specialist dietician put him on what can only be described as weight watchers in reverse .......... including cakes, potatoes, scones, biscuits, full fat yoghurt, full fat cream and more.
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Hepatic Encephalopathy 
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Hepatic encephalopathy 
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