Ascites and cirrhosis... any hope?

[xeliex]

My aunt is suffering from ascites and cirrhosis.

She is not a drinker nor has hepatitis, but the suspected cause of sudden ascites and cirrhosis is long term (undiagnosed) fatty liver and possibly a blood clot from COVID-19.

She is needing frequent paracentesis and is on lactulose. Without lactulose, her mental status is altered due to ammonia.

My poor aunt is spending most of her days in the bathroom due to the laxative effect of lactulose. Doctors haven't offered alternatives and are saying that this is the only way to keep her from hepatic encephalopathy. She is on blood thinners but the liver doesn't seem to be improving.

I recently heard Ray in a interview say that combining CO2 with ammonia converts it to urea. How does one incorporate that?

Any advice that you might offer would be appreciated. The 5+ bowel movements per day are no fun for an elderly lady nor is the disease itself

 

[tankasnowgod]

My aunt is suffering from ascites and cirrhosis.

She is not a drinker nor has hepatitis, but the suspected cause of sudden ascites and cirrhosis is long term (undiagnosed) fatty liver and possibly a blood clot from COVID-19.

I would think this would suggest higher doses of Vitamin E would be helpful. It helps to prevent clots in the first place, and there are several studies showing benefits from doses of 800 IU (and higher) for NAFLD and NASH. Maybe get a few of the studies from here (or by searching pubmed), and show them to your aunt and/or her doctors.

She is needing frequent paracentesis and is on lactulose. Without lactulose, her mental status is altered due to ammonia.

Did they put her on any diuretics? In the studies I've seen with ascites, they frequently use both furosemide and spironolactone. I have seen a few studies that use courses of urea (anywhere from 30-90g a day for a 4-7 day course, with breaks and then repeated). They do these with the above two diuretics.

Treatment of hyponatremic cirrhosis with ascites resistant to diuretics by urea - PubMed

We have studied the efficacy of urea in the treatment of hyponatremia and hydrosaline retention in cirrhotic patients with ascites resistant to diuretics. In 5 patients with hyponatremia and ascites resistant to a major diuretic treatment (200-400 mg spironolactone combined with 40-160 mg...

pubmed.ncbi.nlm.nih.gov

Use of urea for treatment of water retention in hyponatraemic cirrhosis with ascites resistant to diuretics.

www.ncbi.nlm.nih.gov

I might have posted more in this thread-

Post Your Urea Success Stories

So I got my USP urea a week ago. I was able to get a much cheaper source, from www.rpicorp.com. One 500g bottle cost me only $25 plus $17 shipping to a US address =$42. Costs about 40% of what sold at Health Natura or at LifeGiving Store. It makes sense to buy from RPI only if you're using large...

raypeatforum.com

My poor aunt is spending most of her days in the bathroom due to the laxative effect of lactulose. Doctors haven't offered alternatives and are saying that this is the only way to keep her from hepatic encephalopathy. She is on blood thinners but the liver doesn't seem to be improving.

There have been a few alternatives (for ammonia) suggested here, from a low protein diet, to ceylon cinnamon, ornithine, and benzoic acid. In reading about glycine, I've seen that it might also be helpful for detoxing ammonia.

I recently heard Ray in a interview say that combining CO2 with ammonia converts it to urea. How does one incorporate that?

Bag Breathing? A tank of CO2? Lot's of bicarbonate supplementation? Moving to a high altitude or an altitude tent?

Increasing CO2, while maybe straight forward, does seem to be one of the more difficult or awkward things to do. Maybe email Peat about this, since it's such a specific condition?

Any advice that you might offer would be appreciated. The 5+ bowel movements per day are no fun for an elderly lady nor is the disease itself

Yeah, that does not sound pleasant at all. Hope some of the above may help.

 

[Peatness]

Taurine-induced diuresis and natriuresis in cirrhotic patients with ascites

Taurine-induced diuresis and natriuresis in cirrhotic patients with ascites - PubMed

Taurine is a non-protein sulfur amino acid widely distributed in mammalian tissues, with poorly understood functions. Taurine administration has a variety of hemodynamic effects, including improvement of cardiac function and suppression of sympathetic activity. Increased urinary volume and...

pubmed.ncbi.nlm.nih.gov

 

[xeliex]

Thank you so much for the replies Tanka and Pina.

I have seen the Taurine hamster study and I don't think taurine can hurt - but I got resistance from my cousin that it hasn't been replicated and it's in hamsters.

This all unfolded so fast. One day out of the blue she felt pain when breathing; went to the doctor and sent for imaging to be told she has ascites and NASH/cirrhosis.

She was put on lasix and spironolactone but they weren't helping too much.

The urea is interesting; I will look into it further.

From my clinical background, I remember that ascites patients that were put on low protein diets didn't fair well. We gave them high BCAA formulas that slowed down the encephalopathy somewhat though.

Vitamin E, glycine, ceylon cinnamon, ornithine, taurine, bag breathing, and benzoic acid are great suggestions - gonna look into them for her.

Thanks again for your input and compassion.

 

[Peatness]

I'm wondering if progrestrone might help too

From Dr Peat

"Scleroderma, liver cirrhosis, fibrosis of the lungs, heart, and other organs, and all the diseases in which fibrous tissue becomes dense and progressively contracts, involve similar processes, and the treatments which are successful are those that stop the inflammation produced by the oxidation of the polyunsaturated fatty acids."

“The safest (anti-inflammatory substances) are sugar, aspirin, pregnenolone, DHEA, progesterone, thyroid hormone, lidocaine, testosterone, and food sources of magnesium and calcium. "

 

[aliml]

Foods that Increase Ornithine​

Ornithine is considered non-essential; we don’t need to eat it because our bodies can make it. However, some foods measurably increase ornithine in the blood. Surprisingly, the foods that appear to increase blood ornithine the most are grain proteins and watermelon [40, 15].

People who ate a diet high in grain proteins had significantly higher ornithine levels than those who ate mostly meat or dairy proteins. Meanwhile, people who drank large quantities of watermelon juice (more than a kilogram per day) experienced an 18% increase in blood ornithine [40, 15].

To increase your grain protein intake, choose whole grains with high protein content like quinoa and amaranth [41].

5 Ornithine Benefits (incl. Sleep) + Side Effects - SelfDecode Supplements

Ornithine is a non-essential amino acid that may improve recovery from exercise or injury. Learn about its formulations & effects here.

supplements.selfdecode.com

Current treatments of hyperammonemia.​

Name of Medicines​	Pharmaceutical Name​	Mechanism of Action​	Drawbacks​	Ref.​
Lactulose a​	Enulose​	acidification of the colonic contents, increase in osmotic pressure, cathartic effect​	customized drug dosage, abdominal cramping, bloating, flatulence, electrolyte imbalances​	[20,21]​
Rifaximin a​	Xifaxan​	inhibition of RNA synthesis in intestinal bacteria​	high cost, nausea, bloating, diarrhea, antibiotic resistance​	[22,23]​
Sodium benzoate a​	Ammonul​	decrease glycine degradation, increaseglycine elimination​	headache, nausea, impaired mental status​	[24,25]​
Sodium phenylacetate/phenylbutyrate a​	Bupenyl​	decrease glutamine degradation, increase glutamine elimination​	complication for patients with hypertension.​	[26,27,28]​
l-arginine a/l-citrulline a​	l-arginine/l-citrulline​	activation of UC​	gastrointestinal distress, increase plasma citrulline, diarrhea​	[29,30]​
Carglumic acid a​	Carbaglumic acid​	activation of UC through N-acetylglutamate restorement​	chills, body aches, flu symptoms, sores in the mouth and throat​	[31,32,33]​
Albumin-based a dialysis​	Prometheus®, Hepa Wash®, MARS​	elimination of albumin-bound substances​	mild thrombocytopenia​	[34]​
Peritoneal dialysis a​	​	decrease of blood ammonia by transporting ammonia from vascular system to peritoneal cavity​	mild to moderate nausea and vomiting​	[35,36]​
Neomycin b​	Neomycin​	inhibition of protein synthesis in intestinal bacteria​	oto-, neuro-, nephrotoxicity​	[37]​
Metronidazole b​	Metronidazole​	inhibition of nucleic acid synthesis in intestinal bacteria​	oto-, neuro-, nephrotoxicity​	[38,39]​
Glycerol phenylbutyrate b​	Ravicti​	decrease glutamine degradation, increase glutamine elimination​	diarrhea, flatulence, headache​	[40,41]​
l-ornithine phenylacetate b​	l-ornithine phenylacetate​	activation of UC, activation of glycine and glutamine synthesis, increases glycine and glutamine elimination​	severe stomach cramping and diarrhea​	[42,43]​
l-ornithine/l-aspartate b​	l-ornithine/l-aspartate​	activation of UC​	severe stomach cramping and diarrhea​	[44,45,46]​
l-carnitine b​	l-carnitine​	activation of UC​	nausea, stomach discomfort​	[47,48]​
Branched-chain amino acids (BCAA) b​	​	decrease glutamine degradation, increase glutamine elimination​	increase of blood ammonia​	[49,50]​
Bioartificial liver support systems c​	AMC bioartificial liver®, Excorp®, HepatAssist®​	support for liver metabolic activity​	a minor decrease in arterial ammonia, bleeding​	[51,52]​
Liver cell transplantation c​	​	activation of UC​	portal vein thrombosis, shunting of liver cells into the systemic circulation, scarcity of donor organs​	[53,54,55]​
Stem cell transplantation c​	HepaStem®​	activation of UC​	short time efficiency, autoimmune reaction​	[56,57,58]​
Adenovirus associated gene delivery c​	Ornithine transcarbamoylase/Arginase 1 gene delivery​	activation of UC​	safety problem of the viral delivery system, short- time efficiency​	[59,60]​

UC: urea cycle; a Standard therapeutic agents; b Alternative therapeutic agents; c Therapeutical agents under investigation.

Investigational pharmabiotic approaches for hyperammonemia treatment.​

​	Bacterial Species​	Mechanism of Action​	Approved Indication​	Ref.​
Probiotic​	Lactobacillus Plantarum​	Direct Ammonia Consumption in the Gut​	increase the survival rate of mice and decreased blood and fecal ammonia concentration in acute or chronic liver failure, a decrease of astrocyte swelling in the brain cortex in the acute liver failure mice model​	[93]​
​	Lactobacillus helveticus NS8​	regulate the 5-HT nervous system and maintain immune system homeostasis​	improve cognitive decline and anxiety-like behavior​	[94]​
​	Lactobacillus acidophilus​	modify the intestinal flora​	treat MHE in liver cirrhosis and improvement in cognitive performance​	[95]​
​	Enterococcus faecium SF68​	enhance tolerance to protein load, lower ammonia levels, and improve neurological symptoms​	the long-term treatment of patients with cirrhosis and grade 1–2 hepatic encephalopathies, and in improving mental state and psychometric performance​	[96]​
​	Lactobacillus rhamnosus GG (LGG)​	LGG has the ability to attach to the intestinal mucosa and promote epithelial function against the pathogens and promote other beneficial microbiota and stimulate the host immune system through soluble molecule crosstalk​	reduction in endotoxemia and reduction in gut dysbiosis with improved gut microbiome-metabolome linkages​	[97]​
​	Lactobacillus plantarum NCU116​	downregulating lipogenesis and upregulating lipolysis and fatty acid oxidation-related gene expression​	improving liver function, oxidative stress and lipid metabolism​	[98]​
Probiotic mixture​	VSL#3 (Bifidobacterium sp. Lactobacillus sp. Streptococcus thermophilus)​	VSL#3 can modulate the gut microbiota–short chain fatty acid (SCFA) butyrate hormone axis.​	slightly decrease arterial ammonia levels, improve clinical symptoms and lower the risk of HE episodes​	[99]​
Synbiotic​	Pediacoccus pentoseceus Leuconostoc mesenteroides Lactobacillus paracasei subspecies paracasei 19 Lactobacillus plantarum 2592 fermentable fiber​	affecting the extraintestinal translocation of pathogens, reduces the incidence of the pathogen, no–urease-producing Lactobacillus sp. increase​	significant reduction in the blood ammonia levels and reversal of 50% of patients with MHE​	[100]​

MHE: minimal hepatic encephalopathy.

The Pharmabiotic Approach to Treat Hyperammonemia

Ammonia is constantly produced as a metabolic waste from amino acid catabolism in mammals. Ammonia, the toxic waste metabolite, is resolved in the liver where the urea cycle converts free ammonia to urea. Liver malfunctions cause hyperammonemia that leads ...

www.ncbi.nlm.nih.gov

 

[konatowntom]

Dr Burt Berkson has had a lot of success using ALA (Alpha Lipoic Acid) for healing the liver. You can find his videos on youtube.
He has written a book entitled, "The Alpha Lipoic Acid Breakthrough."
You can also contact his office in Las Cruces, NM at (575) 524-3720.
He recommends only using ALA that is sourced from Europe as he didn't get the same results with ALA sourced from China.
You can order ALA from BioTech 1-888-906-4304

 

[youngsinatra]

If you have cirrhosis it‘s basically endgame for the liver, and the bad thing about it is that liver is of huge importance for general health.

I actually think that there is little chance for recovery or improvement, once it progressed to that stage, but trying is always better than doing nothing.

That’s why it’s so important to keep track of your liver health as liver disease is something that you don‘t necessarily notice until the later stages.

 

[konatowntom]

I disagree, it has been shown that the liver can regenerate. Check out some of Dr Berkson's videos. It doesn't have to be a death sentence.

 

[youngsinatra]

I disagree, it has been shown that the liver can regenerate. Check out some of Dr Berkson's videos. It doesn't have to be a death sentence.

I‘ll check it out. Thanks.

 

[peateats1]

My aunt is suffering from ascites and cirrhosis.

She is not a drinker nor has hepatitis, but the suspected cause of sudden ascites and cirrhosis is long term (undiagnosed) fatty liver and possibly a blood clot from COVID-19.

She is needing frequent paracentesis and is on lactulose. Without lactulose, her mental status is altered due to ammonia.

My poor aunt is spending most of her days in the bathroom due to the laxative effect of lactulose. Doctors haven't offered alternatives and are saying that this is the only way to keep her from hepatic encephalopathy. She is on blood thinners but the liver doesn't seem to be improving.

I recently heard Ray in a interview say that combining CO2 with ammonia converts it to urea. How does one incorporate that?

Any advice that you might offer would be appreciated. The 5+ bowel movements per day are no fun for an elderly lady nor is the disease itself

Niacinamide should help and will lower ammonia. Also, I asked peat about ascites in the past and he said thyroid was very very important. Coffee is something else that would help the livers overall health I believe.