Lifestyle changes, nutrition, and supplements for hep b

General Discussion
21

Hi Joan,
I’m not sure how to post this to Thomas, so I am posting it to you as it kind of relates to the topic here.
I confused and concerned about my most recent fibroscan and liver ultrasound reports. According to the fibroscan, the fatty liver score is 240 dB/m, the stiffness score 6.6kPa, the IQR/Median ratio: 29%. Last January, my cap score was 186, and stiffness score is 4.6. Within one year, both the stiffness and fatty scores have increased, but the impressions remain the same: Steatosis grade: S0, Liver stiffness grade:F0. My own interpretation is that I have now advanced into F2, which worries me to no end. I thought I have been eating healthy: daily intake of vegetables and fruits, and weekly rotation of salmon, shrimp, chicken and beef. No processed foods, no sweets but I do tend to eat a lot of pasta. But I don’t think I ate more carbs in 2020, than in 2019. So my question: are the stiffness and fattiness increase a result of hepatitis B despite the diet? Would hbv win out over diet and leave me with no control of maintaining my liver?
About the liver ultrasound, the report of 11/20/2020 said: “Negative complete abdominal ultrasound.” According to the 6/23/2020 report, the liver is “somewhat heterogeneous in appearance with increased echogenicity consistent with fatty infiltration. No discrete liver mass is seen. the liver measures 15.0cm.” The liver now measures 15.4cm. In 10/18, it measured 13.4 cm. The procedures were done at two different clinics. I wonder if that may/could be a reason for the different result.
Both the gastroenterologist and the hepatologist said the bigger liver is O.K. probably because my liver function panel is normal.
What is your interpretation of the stats of both the Fibroscan and the liver ultrasound?

Best,

Tehmin

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22

Hi Tehmin,

Welcome to HepBcommunity and thanks for sharing your story with us all.

There’s a lot of things that can affect your stiffness score other than fibrosis (including inflammation, having a higher BMI, having a different operator of the equipment, different time of day, etc.). That’s why there is a range of values for defining fibrosis score. With Hep B, the F0-F1 range (no to mild fibrosis) is 2-7, which you are in and which is probably why your doctors aren’t too concerned about it. You would need more than 2 data points to say for sure that you are continually increasing in CAP or F scores, so I would recommend staying under monitoring. Also, since nothing is really certain yet, I would hold off on worrying about it (easy to say, but difficult to do, I know).

Regarding Hep B and fatty liver, it seems to be the other way around: Hep B patients are less likely to have fatty liver (for unknown reasons).

Fatty liver and exactly how it comes about is still very difficult to understand, but it sounds like you’ve got the fundamentals down. I would consult with your hepatologist to see what they recommend. It’s also important to note that many of the problems that occur due to fatty liver occur over decades, so you knowing about it now helps you immensely with preventing any long-term issues. See it more as a marathon not a sprint. Keep working at it!

Hope this helps a bit.

Cheers,
Thomas

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Hi Tehmin, so glad you joined the hepbcommunity.org forum! So nice to hear from you. I want to reinforce what Thomas wrote below. He’s a highly trained hep b research scientist and knows of what he speaks! I want to also direct you to the Memorial Sloan Kettering page about how to read a fibroscan report so that you can read for yourself the score range and interpretations. And yes, you are doing everything right. Unfortunately Asians like us can suffer from what is informally called “lean fatty liver disease.” Meaning if our BMI is normal and our diet is healthy, we can still suffer from mild fatty liver disease. In previous posts I wrote about this because my GP wants to start me on a statin since my cholesterol and triglycerides have significantly increased. Ugh! Not sure I can lose 10% of my body weight in the next 6 months, which is what she thinks could help, but it would be nice to be down to my wedding weight again. Anyhow, my recommendation is to keep doing what you’re doing - eat healthfully, reduce stress, exercise, stay calm - and now that you’re retired, it should be easier to keep your stress level down!!! Stay in touch and again, so glad you joined the forum. Always, Joan

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24

So good to hear so promptly from both you and Thomas. I now know that I do have liver fat (woe and whew!), first picked up by the liver ultrasound of last June and now confirmed by the most recent fibroscan. The problem is I can’t afford to lose 10% of my body weight as I am 5’4" and 104 pounds on most days. My lipid panel is normal. Nonetheless I am going to cut out red meat and see what happens at the next round of labs. By the way, my mother also has the oxymoronic lean fatty liver disease–perhaps it runs in the family.
I am grateful for the opportunity to voice my anxiety–writing it out helps me look at the condition in the eye–and grateful for the calming effect of Thomas’s response and yours.

Best,
Tehmin

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25

Thanks Tehmin for your positive feedback. And yes, I agree that being able to express our fears and anxieties, does a lot to reduce our stress as well as give us facts with which to deal with our situations. And wow, you are a very lean person!! I’m ashamed to admit that I really could afford to lose 10% of my weight without any problems. But you are indeed at your minimum weight. So one thing that my hepatologist recommended (and I also checked reliable sources online as well) was to eat a more “mediterranean diet,” which is loaded with vegetables, nuts and fish. So trying to reduce the amount of red meat in your diet could help. The good news is that you’re an F0 so your liver is still in healthy shape. The issue will be over time what happens. So that’s why regular monitoring is important! You’re doing everything right Tehmin so stay calm and relaxed :slightly_smiling_face: Always, Joan

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26

Any thoughts on protein shakes and other powder shakes (collagen peptide, vegetable powder mix, etc).

Anybody taking protein shakes or any powder based drinks as supplements? I read on a workout forum that one was advised by his doctor to stop due to his liver levels up. Why most had no issues. I m guessing non of them are hepatitis b positive. We being CHB have to more aware and cautious, so before I got GNC, wondering if anybody has any advice. Thanks

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27

Hi @NeptuneJ,

I wrote in HBlist a while ago something about some of the supplements that go into some of these protein powders/shakes: some people have had very bad reactions to supplements (https://pubmed.ncbi.nlm.nih.gov/22809474/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4848993/), even cumulating to liver or kidney failure (https://www.abc.net.au/triplej/programs/hack/how-getting-shredded-on-protein-shakes-can-risk-your-health/8879360). Some can cause HBV to replicate even better (https://pubmed.ncbi.nlm.nih.gov/31204557/). The Hep B foundation also has a page on this (https://www.hepb.org/blog/protein-myths-and-your-liver/).

However, I can’t see anything just looking at high protein itself and liver injury, so it may be fine if it’s just clean protein. A caveat though: many of these products are not well-regulated, so there could be things that affect you and your liver health.

Too much of anything is going to be problematic. For nutritional studies in particular, you can almost always find studies that support your case and go against your case. The issue is that people are complex, what we eat is complex, and what we do is complex. Each needs to be suited for your particular circumstance, and there’s no magic bullet or rule (e.g. just eating green things) that will automatically speed up your health.

What the scientific studies have shown most robustly (i.e. over many independent studies) is that 1) exercising; and 2) limiting (though not necessarily eliminating) consumption of trans-fats, simple sugars, and salt will probably help most people. I would take the advice of the WHO for this: https://www.who.int/news-room/fact-sheets/detail/healthy-diet

Relatedly, I recently started doing some intense 6am boxing and bootcamp classes, and had a blood test (LFTs) directly after a class once. My ALTs were up around 300, which was weird because this was a repeat of a test I had 2 weeks earlier that was normal (they had collected the wrong tubes for one of the tests).

Anyway, I called up my hepatologist and she said that intense exercise can also increase ALTs. This is because when you exercise, you make micro-tears in your muscle and ALT can leak out into the blood and affect the readings. She caught it because there were so many people doing exercise as a New Year’s resolution that she was seeing a spike with all of her other patients as well.

What this means is that increased exercise can 1) give a false reading of liver damage; and 2) mask actual liver damage, if you’re not careful in interpreting the results for a person. A couple of the clinicians I talked to were also surprised to hear of this phenomenon, so don’t assume that this is common knowledge.

The solution is to get a blood test as far away from your last workout as possible (rule of thumb: if your muscles still ache, you should still probably wait). I repeated mine 3 days after my last workout and my ALTs were normal again.

Hope this helps,
Thomas

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28

Thanks Thomas for sharing your story about elevated ALT’s after exercising. Never heard of that, but then again, I don’t ever work out as hard you probably do!! So Neptune, I’m not sure whether you think you’re protein deficient or whether you’re trying to build up muscle mass as part of an exercise regimen? Overall, I know that over the past 2 decades, I’ve heard from a lot of nutritionists who spoke at the Hep B Foundation’s patient conferences (we held them from 2000-2010) who discouraged protein shakes and supplements. Too much protein can really stress a liver. And if it’s artificial protein such as found in shakes and mixes, as Thomas said, they’re not well regulated and could actually cause more damage than good. I know that I’ve always been more wary of taking supplements and powders/mixes because of my liver health. With that said, Neptune if you’re interested in extra protein, then it would probably be a good idea to speak with a nutritionist for a healthy way to incorporate more into your diet. Thanks for asking and hope I’m not being too much of a downer! Always, Joan

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29

Agree. In the Philippines, YWSP (our organization) does not promote any supplements. We believe eating and exercising moderately. Each of us has its own capacity. If we have fatty liver, we eat steam foods and avoid pork and beef. Discipline is the key.

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As a HBV patient advocate I’m a foodie I find it very difficult switching over to a liver healthy diet. Lord knows I want to but dear heavens are there any advice as to an easier path to try this? My barriers are

A) taste
B) color
C) texture

Those my 3 barriers most healthy food don’t appeal to my taste buds. Green is not my color and texture such as oakra, lima beans, wheat pasta ect have a funny grainny feel and a very earthy after-taste

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31

Knowledge and information has been my saviour.

I researched about every piece of junk I used to love to eat/drink from cheesy pizzas to rich savouries to drinks loaded with sugar.

I knew I had HBV since 2008 but given how big of a foodie I was, I managed to gain ~80 Kgs in about 10 years after my initial diagnosis. Stupid as it may sound, I choose to do all these attrocities to my body and liver, I choose to ignore my condition despite of clear instructions from my doctors.

And last year, one day It all came back and haunted me. My viral count flared up, LFTs were all over the place and I had significant fibrosis (F3-F4) in my liver.

In past 6 months after this horrifying discovery, I researched every piece of food I ate, It all reached to a point, my girlfriend thought I’ve gone compulsive.

So how did it all helped me and how can it help you?

I think information is powerful tool, our brains are incredibly good when it comes to survival. It makes us feel fearful, anxious, guilty and reluctant, if it knows something is bad for the body it is supposed to protect.

So by feeding it with loads of information about the subject, In this case, food. I automatically found myself repelled to the usual junk I used to eat and shifted to eating very basic items. In my case I never had cravings too.

I know its just a theory but I believe it works. You can overcome any form of addiction, from nicotine to carbohydrates by just studying more and more about it, gaining as much information as you can.

PS, I’m doing fine now, after 6 months, I’ve lost close to 40 Kgs, my fibroscan results are significantly better and my viral load has gone low enough to remain undetectable in commercial PCR tests.

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32

That great news. I try to eat healthy from last year. But I do fall off the healthy diet car once in awhile. It’s hard.

It’s hard because it’s a life style change. Especially working from home. They say if you can pass 3montgs it get easier

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33

Shucks I can’t pass 2 days I’m a serious foodie. But I’m working on things to improve my health and longevity. It takes discipline…I suppose. I know I can do it

Reverend Jason Crum-Escalera

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34

Perhaps maybe we can share recipes of our liver healthy diets y’all game?

Reverend Jason Crum-Escalera

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35

You make a great point, @NeptuneJ. In my experience, it is best to introduce small changes that you know you can turn into habits. Then you can start to add more and more changes as you get used to the old ones.

With any dietary changes for long-term health, you need to keep them up over long periods of time - there’s no use going on a crash diet that you can’t keep up.

It’s a marathon, not a sprint. So treat it like one and know your own energy levels (it does take energy/willpower to make changes).

Cheers,
Thomas

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Hi @Jason_Escalera, welcome to the community! What a great idea to share recipes. I would be keen. I think people should start new topics for each recipe and I’ll start assembling them into a new forum category if we get a few of them.

Cheers,
TT

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Well count me in,

Reverend Jason Crum-Escalera

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38

I have found that taking baby steps in changing one’s diet can result in greater success. One of the things that I did to eat more healthfully was to follow a 10-day detox diet that included - you bet - eliminating caffeine, alcohol, wheat products (no bread, pasta), and sugar. I figured I could do anything for 10 days. Of course the first 3 days were really rough. But after that it became much easier. The next step was to adopt more of a plant-based diet so I followed a 21-day menu plan that was so full of wonderful vegetables, nuts and grains that I really didn’t miss meat. The key to success was the use of many spices and a wide variety of vegetables (there are so many choices besides green one!). Let me just say, though, just like Neptune admitted, I have fallen off the wagon at times but at least know how to get back on! Currently, most of my diet is about 70% plant-based and I work hard to avoid sugar and wheat. The wheat is justified because I found that I actually have one positive Celiac disease marker after being worked up for a severe iron storage deficiency. My hemoglobin is fine so I’m technically not anemic. I just don’t store much iron. Anyhow, TMI. With that said, I like the idea of folks sharing recipes, support for eating a liver-healthy diet!! Always, Joan

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Hi Joan. When you say plant base does that mean your viand is made up of plant (look a like meat) or purely veggies? Am not sure how you do it there but I read that some entrepreneurs cook meat but the meat are really plants and not from beef, chicken or pork.

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40

Hi @YellowWarriorsPH (Chris?) - when I say “plant-based,” it means that I make meals with lots of vegetables and whole grains (as well as eat a lot of fruit). In regards to the “plant based” meats that are being promoted, there’s a good article at https://www.insider.com/plant-based-meat, which explains their benefits and how they’re made. Here in the U.S. I’ve eaten the “impossible burger” sold by Burger King to see what all the fuss is about - it’s not bad! But since I eat burgers so rarely, I’d rather eat a “real” one since the plant based burgers include wheat gluten, which is something I try to avoid. The best “diet” declared recently here in the U.S. is the “Mediterranean Diet” - what folks essentially eat in Greece! Lots of fruits, veggies, nuts, olives and fish (rarely meat). Thanks for asking … always, Joan

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