Best Nutritional Supplements for Patients with Hepatic Encephalopathy

Q: Best Nutritional Supplements for Patients with Hepatic Encephalopathy

Hello： For patients with hepatic encephalopathy and liver-related brain disorders, protein intake should be adjusted based on their condition in consultation with a physician or dietitian. <br>For those with severe confusion, a moderate restriction of protein intake is recommende

Nutritional Supplements Suitable for Hepatic Encephalopathy

Hello: My mother is in hepatic coma and needs to drink probiotics.
We want to reduce some meat protein and supplement protein through nutritional products.
May I ask: 1.
What nutritional products can supplement protein with minimal or no ammonia production? 2.
What nutritional products are suitable for patients with hepatic coma? Thank you.

CD, 40~49 year old female. Ask Date: 2023/01/16

Dr. Huang Yuru reply Nutrition

Hello: For patients with hepatic encephalopathy and liver-related brain disorders, protein intake should be adjusted based on their condition in consultation with a physician or dietitian.
For those with severe confusion, a moderate restriction of protein intake is recommended, controlling protein consumption to approximately 0.6-0.8 grams per kilogram of body weight per day.
For patients whose condition stabilizes and improves, protein intake can be gradually increased to about 1-1.2 grams per kilogram of body weight per day.
For example, an adult weighing 60 kg who needs to limit protein intake should restrict their daily protein consumption to 36-48 grams, which is about 3-4 servings of protein foods per day (where 2-3 finger widths is considered one serving).
For those whose condition stabilizes and can return to normal protein intake, daily protein consumption can reach 60-72 grams, approximately 6-7 servings of protein foods per day (again, 2-3 finger widths is one serving).

Any protein metabolism produces ammonia, so it is advisable to prioritize plant-based proteins (such as grains, soy products like tofu, dried tofu, and soy milk) or dairy proteins, as they have a lower proportion of sulfur-containing amino acids compared to animal proteins.
Additionally, they are rich in branched-chain amino acids and dietary fiber, which are less likely to burden the liver and can help stabilize gut microbiota, increasing ammonia excretion through feces.

1.
Most commercially available nutritional products use casein, whey protein, or soy protein as protein sources, and their formulations contain a certain proportion of protein, which will produce nitrogenous waste upon metabolism; currently, there are no nutritional products that can supplement protein while producing almost no ammonia.

2.
The choice of nutritional products should be evaluated based on individual health conditions and body weight, and it is recommended to discuss with a physician and dietitian.
Generally, a balanced nutritional formula is suggested; however, consideration should still be given to the amount of protein consumed through oral intake for combined use.
If hepatic encephalopathy has progressed to the point of causing confusion, it is recommended to switch to a low-protein formula.
Wishing you good health.

Reply Date: 2023/01/16

More Info

When dealing with hepatic encephalopathy, particularly in patients who are experiencing liver failure or significant liver dysfunction, nutritional management becomes crucial. Hepatic encephalopathy is a condition that arises due to the accumulation of toxins, particularly ammonia, in the bloodstream, which can occur when the liver is unable to adequately filter these substances. Therefore, dietary choices, especially regarding protein intake, must be carefully considered.

1. Protein Sources and Ammonia Production: It is important to note that all protein metabolism produces ammonia to some extent, as ammonia is a byproduct of amino acid breakdown. However, certain protein sources are less likely to contribute to elevated ammonia levels. For patients with hepatic encephalopathy, it is generally recommended to limit protein intake to about 0.6 to 0.8 grams per kilogram of body weight per day during acute episodes, and potentially increase to 1.0 to 1.2 grams per kilogram as the patient's condition stabilizes.
The best protein sources for these patients are typically plant-based proteins and dairy proteins. Plant-based proteins, such as those found in legumes (like beans and lentils), whole grains, and soy products (like tofu and tempeh), tend to produce less ammonia compared to animal proteins. Dairy products, particularly those that are low in sulfur-containing amino acids, such as yogurt and milk, can also be beneficial.
Unfortunately, there are no commercially available protein supplements that can provide protein without producing ammonia. However, some specialized medical nutrition products are designed for patients with liver disease and may contain a modified amino acid profile that is easier for the liver to process. These products often include branched-chain amino acids (BCAAs), which can be beneficial in managing hepatic encephalopathy.

2. Nutritional Supplements for Hepatic Encephalopathy: For patients with hepatic encephalopathy, it is essential to focus on a balanced diet that provides adequate calories and nutrients while minimizing the risk of ammonia accumulation. Nutritional supplements that are often recommended include:
- BCAA Supplements: These can help improve nitrogen balance and may assist in reducing the severity of hepatic encephalopathy. They are particularly useful in patients who are protein-restricted.

- Low-Protein Formulas: These are specially formulated to provide essential nutrients while limiting protein intake. They can be beneficial for patients who need to restrict protein due to their liver condition.

- High-Calorie Nutritional Drinks: These can help maintain caloric intake, especially if the patient has a reduced appetite. Products like Ensure or Boost can be considered, but it is essential to choose those that are lower in protein if the patient is on a restricted protein diet.

- Probiotics: Some studies suggest that probiotics may help improve gut health and reduce ammonia levels by promoting a healthy gut microbiome.
In summary, for patients with hepatic encephalopathy, it is crucial to work closely with healthcare professionals, including a registered dietitian, to tailor a nutritional plan that meets their specific needs. This plan should focus on minimizing ammonia production while ensuring adequate caloric and nutrient intake. Regular monitoring and adjustments based on the patient's condition are essential to optimize their nutritional status and overall health.

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