Physicians believe that cognitive difficulties, poor
short-term memory, and confusion only occur in patients with cirrhosis. I think
that this information is incorrect. I believe that these problems (which
are commonly referred to as brain fog by hepc’ers) can occur at much earlier
stages. I know too many people that have a lesser stage of disease and a
big problem with this. It seems to be transient in nature.
If you notice this problem, you might consider restricting the
amount of protein that you eat. Protein contains an ammonia
molecule. In cirrhosis protein metabolism is affected and the body is not
able to clear this molecule. It is usually removed by conversion to urea
which is synthesized in the liver. If it is not taken out of the blood it
can accumulate and lead to hepatic coma. As it builds it causes many
cognitive problems and it is common for people with cirrhosis to be restricted
in their protein intake in addition to being prescribed lactulose, which reduces
the circulating ammonia.
It is important to note that you must have a minimum of 20-30
grams of protein in your diet to prevent protein loss from muscle tissue.
In a newly released study this week it was noted that between 45-55% of Canadian
women do not meet the daily minimum requirements for protein.
Another thing to keep in mind is that we want the liver tissue
to regenerate. To make new tissue you must have protein. So too much
or too little protein is a problem.
If you become aware of an increase in cognitive difficulties,
try reducing your protein. Many people feel better when they do not eat
red meat. Chicken and fish does not seem to be as big a problem.
Special note: A lack of insulin production (diabetes)
also leads to a reduction in protein synthesis.