Showing posts with label liver health. Show all posts
Showing posts with label liver health. Show all posts

Sunday, February 3, 2019

2019 February Hepatitis Newsletters: Finding Support

Valentine's Day is almost here, either you love it or hate, right? Me. Hate it. In any event, while you're waiting for either flowers, candy, diamonds or a sandwich, sit back and read this month's viral hepatitis newsletters, written by inspiring individuals that spread hope and love all year long.

Finding Support
Finding support online can be extremely useful when you're faced with decisions about HCV treatment or care. But remember folks, a support site, forum, or blog, should offer only personal experiences, and support, not medical advice. Understand any information you receive about HCV treatment, liver health or medications doesn't come from medical professionals and is not meant to replace your professional care. With that said, I highly suggest you check out the following support forums and my fav Facebook page.

Karen Hoyt's Facebook Page - Happy Valentine's Day!
Visiting Karen's Facebook page is like taking a class without leaving home. Karen covers it all, from tips on liver health, creating a well-balanced meal, to her own journey living with cirrhosis, liver cancer, and the emotional ups and downs of a lifesaving liver transplant. Visit her website and YouTube channel as well. Not done yet, if you haven't read her book, check it out, here.

Hep Forums 
Hep Forums  is a safe place to learn, share and exchange ideas. The forum provides moderated peer-support for people who have Hepatitis B, C or a co-infection. View all posts here, or start with this recent post: Started Epclusa today 2/1/2019.

Recommend Support Forums
Hep Forums
Hep C Warriors
Hep
Hep is an award-winning print and online brand for people living with and affected by viral hepatitis. Offering unparalleled editorial excellence since 2010, Hep and HepMag.com are the go-to source for educational and social support for people living with hepatitis.
Stay Updated
News 
Highlights
Want to Stop Fatty Liver Disease? Cut Back on Sugary Drinks!
Undiagnosed Hepatitis Common Among People With Cancer
Start here...

 infohep.org
The aim of infohep.org is to develop a high-quality online resource to increase awareness of viral hepatitis, its treatment, and the needs of people living with viral hepatitis in Europe.
The Latest News & Research:
January Bulletin 
Highlights
Lancet Commission recommends actions to support elimination of hepatitis C
HCV modelling study
HIV/HCV co-infection and end-stage liver disease
Survival after liver cancer diagnosis is shorter in people living with HIV
Conditional cash transfers to encourage hepatitis C diagnosis and treatment in people who inject drugs
Barriers to HCV treatment in people who inject drugs
TAF for hepatitis B
AbbVie legal challenge in UK tender exercise dismissed
Begin here...

 HCV Advocate
The HCV Advocate newsletter is a valuable resource designed to provide the hepatitis C community with monthly updates on events, clinical research, and education.
What We Need to Eliminate HCV
I Heart Liver
Hepatitis Headlines

Stay Updated
What’s Up! News about the upcoming issue of our last HCV Advocate Newsletter this March, our patient HCV video and Packhealth – a patient resource.
Begin here.....

World Hepatitis Alliance
The World Hepatitis Alliance goal is to achieve a world free from viral hepatitis, World Hepatitis Alliance provides global leadership in awareness-raising, advocacy and in efforts to find the missing millions.
Newsletter
In The News

For Your Viewing Pleasure
Highlights
Describe recent advances in HCV management
Review current barriers to HCV screening, testing, and linkage to care
Discuss effective approaches to overcoming barriers to HCV elimination
Click here to read our latest newsletter.

New York City Hepatitis C Task Force 
The New York City Hepatitis C Task Force is a city-wide network of service providers and advocates concerned with hepatitis C and related issues. The groups come together to learn, share information and resources, network, and identify hepatitis C related needs in the community. Committees form to
work on projects in order to meet needs identified by the community.
Hep C Elimination in People Living with HIV
NYC Hep C Task Force Meeting. February 27 (9 AM -2 PM) @ 208 W 13th St. Support Hep C Elimination in PLWH!
All - Hep Free NYC Newsletters

Hepatitis NSW
Hepatitis NSW provides information, support, referral and advocacy for people affected by viral hepatitis in NSW. We also provide workforce development and education services both to prevent the transmission of viral hepatitis and to improve services for those affected by it.
Stay Current
News Updates

'What was your journey to becoming hep C free?'
Over 40,000 Queenslanders are living with hepatitis C. Find out what it's like for those who have lived with the virus and the journey to being cured.



Hepatitis Victoria
Hepatitis Victoria is the peak not-for-profit community organisation working across the state for people affected by or at risk of viral hepatitis.
View the Latest Newsletter, or relax and listen to a short podcasts interviewing health experts and practioners on topics related to viral hepatitis - have a listen!

 The British Liver Trust 
The British Liver Trust is the leading UK liver disease charity for adults – we provide information and support; increase awareness of how liver disease can be prevented and promote early diagnosis; fund and champion research and campaign for better services.
Highlights
Clare's Story
New publication: Thinking ahead - planning for your future...
Support Groups
Liver Disease Toolkit
Liver disease is one of the five most common causes of premature death in the UK and is the only major cause of death that has a year by year increasing incidence. However, more than 90% of liver disease is preventable. The three major causes of liver disease in adults are alcohol-related liver disease, obesity and metabolic syndrome leading to non-alcohol-related liver disease, and viral hepatitis.
News 
View All Newsletters, here.

The Hepatitis C Trust 
The Hepatitis C Trust is run by patients with the goal of eliminating HCV in the United Kingdom. The Trust’s mission is to reverse the rapidly increasing death toll caused by hepatitis C in the UK until no-one dies from this preventable and treatable disease and, ultimately, it is all but eradicated in this country.
Stay Updated
News
Information
Impact of hepatitis C on the liver
Hepatitis C primarily damages the liver. This can have a number of different effects.

National Viral Hepatitis Roundtable
The National Viral Hepatitis Roundtable (NVHR) is national coalition working together to eliminate hepatitis B and C in the United States.
Strategies to Eliminate HCV in Veterans
This webinar highlighted various programs to engage U.S. Veterans in hepatitis C testing and treatment services in the VA and community settings. See the slides and access the archived webinar
Click here for the slides. Click here for the recording. (Click the link, and then enter the requested information to view the webinar).
View all NVHR newsletters

HepC Challenge - Caring Ambassadors Program
The Caring Ambassadors Program uses a unique approach in our work to address the elimination of viral hepatitis and specifically hepatitis C.
Weekly Updates: Hepatitis C News
Topics include all stories related to hepatitis C as well as personal stories and events. To sign up to receive our weekly newsletter sent to your inbox, click here.

National Institutes of Health
A monthly newsletter from the National Institutes of Health, part of the U.S. Department of Health and Human Services.
February Newsletter
Understanding Emerging Diseases
Protect Yourself from Heart Attack and Stroke
Begin here..

In Case You Missed It
AASLD / EASL HCV Special Conference
February 1-2, 2019
Make sure to check out coverage from this months HCV Special Conference.

The Year Of The Liver
Dr. Joe Galati outlines his recommendations to keep your liver healthy. These tips include reducing alcohol, weight loss, avoid processed foods, regular exercise, getting more sleep, and several others



Recommended Blogs 
Karen Hoyt is devoted to offering support and accurate information to people coping with the effects of hepatitis C.

Lucinda K. Porter
Lucinda Porter is a nurse, speaker, advocate and patient devoted to increasing awareness about hepatitis C.

Hepatitis B Foundation
The Hepatitis B Foundation is a national nonprofit organization dedicated to finding a cure and improving the quality of life for those affected by hepatitis B worldwide.

Hep
Hep is an award-winning print and online brand for people living with and affected by viral hepatitis.

Hepatitis NSW
Provides information, support, referral and advocacy for people affected by viral hepatitis in NSW. We also provide workforce development and education services both to prevent the transmission of viral hepatitis and to improve services for those affected by it.

Life Beyond Hepatitis C
Life Beyond Hep C is where faith, medical resources and patient support meet, helping Hep C patients and their families navigate through the entire journey of Hep C.

Canadian Liver Foundation
We strive to improve prevention and the quality of life of those living with liver disease by advocating for better screening, access to treatment, and patient care.

Hepatitis B Foundation
The Hepatitis B Foundation is a national nonprofit organization dedicated to finding a cure and improving the quality of life for those affected by hepatitis B worldwide.

HepatitisC.net
At HepatitisC.net we empower patients and caregivers to take control of Hepatitis C by providing a platform to learn, educate, and connect with peers and healthcare professionals.

HIV and ID Observations
An ongoing dialogue on HIV/AIDS, infectious diseases, all matters medical, and some not so medical.

ADRLF (Al D. Rodriguez Liver Foundation)
Al D. Rodriguez Liver Foundation is a non-profit organization that provides resources, education and information related to screening, the prevention of and treatment for the Hepatitis Virus and Liver Cancer.

CATIE 
We connect healthcare and community-based service providers with the latest science, and promote good practices for prevention and treatment programs. As Canada’s official knowledge broker for HIV and hepatitis C, you can count on us for up-to-date, accurate and unbiased information.

Kevin Pho is a practicing physician and most known for his blog KevinMD. Thousands of authors contribute to his blog: primary care doctors, surgeons, specialist physicians, nurses, medical students, policy experts. And of course, patients, who need the medical profession to hear their voices. 

AGA Blog
Gastroenterology and Clinical Gastroenterology and Hepatology, written by Dr. Kristine Novak.

The goal of our publications is to bring people around the world the most current health information that is authoritative, trustworthy, and accessible, drawing on the expertise of the 10,000+ faculty physicians at Harvard Medical School.

Providing physicians with virtual access to specialists can be lifesaving to liver disease patients.

BMC
The BMC series publishes 65 subject-specific journals focused on the needs of individual research communities across all areas of biology and medicine.

Just Because Its Valentines Day
 


HepCBC
In closing may sure you check out a collection of noteworthy hepatitis C news articles in the latest issue of the Weekly Bull, published by the Canadian non-profit organization HepCBC.

Thank for stopping by!
Tina
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Saturday, February 2, 2019

High‐Quality Diets Associated With Reduced Risk of Liver Cancer and Liver Disease

Hepatology Communications
First Published: 31 January 2019
High‐Quality Diets Are Associated With Reduced Risk of Hepatocellular Carcinoma and Chronic Liver Disease: The Multiethnic Cohort 
David Bogumil
Song‐Yi Park Loïc Le Marchand Christopher A. Haiman Lynne R. Wilkens Carol J. Boushey Veronica Wendy Setiawan

Open Access

Abstract
Hepatocellular carcinoma (HCC) and chronic liver disease (CLD) are major sources of morbidity and mortality globally. Both HCC incidence and CLD mortality are known to vary by race. There is limited research on the association between dietary measures and these outcomes in a diverse population. We prospectively investigated the associations between four diet quality index (DQI) scores (Healthy Eating Index‐2010, Alternative Healthy Eating Index‐2010, Alternate Mediterranean Diet [aMED], and Dietary Approaches to Stop Hypertension), HCC incidence, and CLD mortality in the Multiethnic Cohort. We analyzed data from 169,806 African Americans, Native Hawaiians, Japanese Americans, Latinos, and whites, aged 45 to 75 years. DQI scores were calculated by using a validated food frequency questionnaire administered at baseline. During an average 17 years of follow‐up, 603 incident cases of HCC and 753 CLD deaths were identified among study participants. Multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) for each DQI were estimated using Cox regression. Higher aMED scores, reflecting favorable adherence to a healthful diet, were associated with a lower risk of HCC (quintile [Q]5 versus Q1 HR, 0.68; 95% CI, 0.51‐0.90; trend, P = 0.02). In racial/ethnic‐specific analyses, there was no significant heterogeneity across groups (interaction, P = 0.32); however, the association only remained statistically significant among Latinos (Q4 versus Q1 HR, 0.47; 95% CI, 0.29‐0.79; trend, P = 0.006). All DQI measures were inversely associated with CLD mortality, with no significant heterogeneity by race/ethnicity. Conclusion: Higher aMED scores were associated with a lower risk of HCC. A higher score of any DQI was associated with a lower risk of CLD mortality. These results suggest that better diet quality may reduce HCC incidence and CLD mortality.

Full Article Online:

Recommended Reading
Jan 25, 2019
Misconceptions Surrounding Hepatocellular Carcinoma
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Tuesday, January 22, 2019

Treating alcohol-related liver disease from a public health perspective

Also See
Journal of Hepatology February 2019
Alcohol-related liver disease: Time for action
Ramon Bataller, Gavin E. Arteel, Christophe Moreno, Vijay Shah
The overall landscape of clinical hepatology has markedly evolved in the last few years. Recent major advances in the management of viral hepatitis B and C with highly effective therapies are decreasing the proportion of patients with viral-related end-stage liver disease in many countries.1 Consequently, increasing attention is being paid to fatty liver diseases (both alcohol-related liver disease [ALD] and non-alcoholic fatty liver disease [NAFLD]) as the main current and future driver of liver-related health burdens.
PDF
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Journal of Hepatology February 2019
Volume 70, Issue 2, Pages 223–236
Treating alcohol-related liver disease from a public health perspective
Theresa Hydes†, William Gilmore†, Nick Sheron, Ian Gilmore


Summary
Herein, we describe the evolving landscape of alcohol-related liver disease (ALD) including the current global burden of disease and cost to working-aged people in terms of death and disability, in addition to the larger spectrum of alcohol-related heath complications and its wider impact on society. We further review the most effective and cost-effective public health policies at both a population and individual level. Currently, abstinence is the only effective treatment for ALD, and yet because the majority of ALD remains undetected in the community abstinence is initiated too late to prevent premature death in the majority of cases. We therefore hope that this review will help inform clinicians of the “public health treatment options” for ALD to encourage engagement with policy makers and promote community-based hepatology as a speciality, expanding our patient cohort to allow early detection, and thereby a reduction in the enormous morbidity and mortality associated with this disease.

Full Article: 
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Alcohol-Linked Disease Overtakes Hep C As Top Reason For Liver Transplant

Alcohol-Linked Disease Overtakes Hep C As Top Reason For Liver Transplant
By Rachel Bluth
An estimated 17,000 Americans are on the waiting list for a liver transplant, and there’s a strong chance that many of them have alcohol-associated liver disease. ALD now edges out hepatitis C as the No. 1 reason for liver transplants in the United States, according to research published Tuesday in JAMA Internal Medicine.

One reason for the shift, researchers said, is that hepatitis C, which used to be the leading cause of liver transplants, has become easier to treat with drugs.

Another could be an increasing openness within the transplant community to a candidate’s history of alcohol and addiction and when a candidate combating these issues can qualify for a liver.

For years, conventional wisdom suggested that people with a heavy drinking past who did not have a period of sobriety under their belts would not be good candidates to receive a new liver. But, of almost 33,000 liver transplant patients since 2002 who were studied, researchers from the University of California-San Francisco found 36.7 percent of them had ALD in 2016, up from 24.2 percent in 2002.

“Across the country, and we show in a prior study, people are changing their minds,” said Dr. Brian P. Lee, the study’s lead author and a UCSF gastroenterology and hepatology fellow. “More and more providers are willing to transplant patients with ALD.”

The debate, roiling for decades, culminated in 1997 when a group of doctors and medical societies and the U.S. surgeon general published a paper that recommended patients with alcoholic liver disease be sober at least six months before they could be considered for transplant.

This “six-month rule” became the gold standard. The idea was that a patient who could stay sober for that long had a lower chance of returning to harmful drinking behavior. There was also concern that the public would stop donating organs if they thought livers would be going to people with alcohol addictions.

“Neither of those attitudes are based on any facts or data,” said Dr. Robert Brown, director of the Center for Liver Disease and Transplantation at Weill Cornell and New York Presbyterian.

The changing attitude plays out at many transplant centers where what once was viewed as a hard-and-fast requirement for six months of sobriety is now more nuanced. Specifically, a team of doctors, psychologists and social workers look at a range of factors, including financial stability and family support, to determine if a patient will relapse after the transplant.

An analysis published in 2010 by researchers from the University of Pittsburgh and a 2011 study in France showed that, in any given year, there was little evidence to suggest six months of abstinence before the transplant decreased the chance of relapse.

The central point, experts say, does not necessarily come down to a patient’s record of sobriety before the procedure. Foremost is determining that a patient is unlikely to drink again after receiving a new liver — that he or she is “committed to lifelong abstinence,” said Lee.

Five years after transplantation, patients who were abstinent for six months and those who weren’t had about the same survival rates, according to Lee’s research. After 10 years, the patients who didn’t have six months of sobriety before the procedure had slightly worse survival rates. Lee said more research is needed to find out exactly why.

There is nothing magical about six months, according to Dr. Michael Lucey, medical director of the University of Wisconsin liver transplant program. He said it shows a poor understanding of alcohol abuse as a “very complex behavioral disorder.”

“Drinking isn’t a stable phenomenon,” Lucey said. “People with ALD may have long periods of drinking and abstinence.”

Although advocates are glad that policy is changing, it didn’t change swiftly enough to save Chelsea Oesterle.

Oesterle, who was 24 and had battled alcohol addiction since age 16, went to the emergency room in Peoria, Ill., in 2013, already in liver failure. Doctors told her in the first few days that survival depended on a transplant.

When it became clear she wasn’t going to get that transplant, her mother, Terri Oesterle, had her daughter transferred to another hospital, and between both facilities she spent six weeks hospitalized. During that time, she was never put on a transplant list.

The stigma around her daughter’s condition was palpable, her mother said. Doctors and nurses lectured her about quitting drinking.

“They kept telling her she had to go to rehab,” Terri Oesterle said. “She couldn’t even leave the hospital, how on earth was she supposed to go to a rehab program?”

One doctor point-blank asked Terri Oesterle why she thought her daughter deserved a liver over someone else.

“She was dismissed from the get-go,” Terri Oesterle said. “It’s just heart-wrenching because she was such a sensitive soul. She was so scared and hopeful.”

Chelsea Oesterle died in the hospital July 4, 2013.

Alcohol use disorder has often been thought of as a “self-inflicted” disease that results from bad habits or moral failing, Lucey said. That attitude is changing in the medical community, but vestiges remain.

“For some people, it’s not accepting that alcohol use disorder is an illness,” Lucey said.

While support for the changing approach is growing, Lee, the new study’s lead author, said it continues to be a polarizing issue.

“There are still detractors and still strong opposition,” he said. “Our study suggests that is certainly present, because regional differences are disparate.”

That troubles Lee, because it means a patient’s life is dependent on the attitudes of local providers, creating an unequal system. There’s “certainly value” in a national policy on the issue, he said.

The United Network for Organ Sharing (UNOS), the organization that manages the U.S. transplant list, nearly two decades ago wrestled with the idea of formalizing the six-month rule, but never took final action.

As a result, some centers have such a sobriety rule, others don’t. And even when a transplant center gives its approval, insurers often have their own set of requirements about how long a patient must be abstinent before they will cover the transplant.

Dr. David Klassen, chief medical officer for UNOS, agreed that the “rule” is arbitrary and not evidence-based, but said that it should be up to transplant centers to decide who gets listed for an organ.

“From our perspective, dictating medical care doesn’t lead to the best solutions or the best outcomes,” Klassen said. “I think transplant programs and society as a whole are moving in generally the same direction.”
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Friday, January 18, 2019

Many Popular Dietary Supplements Can Yield Dangerous Liver Results

Many Popular Dietary Supplements Can Yield Dangerous Liver Results
January 15, 2019 
A recent paper from two U-M hepatologists highlights the liver dangers associated with consuming some herbal and dietary supplements designed to build muscle or lose weight.

Athletes often use over-the-counter products to help lose weight or improve their energy and performance levels.

However, the vast majority of herbal and dietary supplements (HDS) never undergo formal efficacy or safety tests because their manufacturing, production and content are not closely regulated by the Food and Drug Administration, says Robert Fontana, M.D., University of Michigan’s medical director of liver transplantation, and Ammar Hassan, M.D., a U-M hepatology fellowship graduate, who have explored several over-the-counter HDS products linked to liver injury.

As the number of HDS products available in the United States continues to grow, more than 80,000 commercial products are available to consumers, with nearly 50 percent of adults reporting regular use of at least one kind of supplement. Many adverse effects are linked to consuming HDS products, including hepatotoxicity, or chemically induced liver damage, according to the Drug-Induced Liver Injury Network.

Fontana and Hassan explored several popular over-the-counter HDS products linked to liver injury in a recent article in Seminars in Liver Disease. Here is a rundown:

Bodybuilding supplement hepatotoxicity

The majority of bodybuilding HDS products that lead to liver injury appear to contain androgenic anabolic steroids (AAS) or are contaminated with these and other chemicals.

AAS are synthetic derivatives of testosterone. Some medical conditions require the use of AAS products, including primary male hypogonadism and hereditary angioneurotic edema, but athletes use many of these steroids without medical supervision for their performance-enhancing and muscle-building properties.

SEE ALSO: Troubling Trends in Drug-Induced Liver Damage

“The use of these products is very common among amateur and professional athletes, including many active-duty military personnel,” Fontana says. “Data suggests that 69 percent of these individuals use at least one HDS product, while 22 percent report using more than three a day.”

These products are often purchased at health food stores or online in bulk. Over the past two decades, a significant increase in the incidence of liver injury related to the illicit use of AAS has been reported.

“Bodybuilding supplements that contain AAS can lead to liver damage, including severe cholestatic hepatitis, which can take months to resolve,” Fontana says. “Additionally, various multi-ingredient nutritional supplements taken to enhance energy, increase performance and facilitate weight loss can lead to potentially severe, or even fatal, liver damage.”

Non-bodybuilding supplement hepatotoxicity

Some of the most frequently used non-bodybuilding supplements associated with hepatotoxicity include green tea extract and multi-ingredient nutritional supplements that contain both botanicals and other compounds. These products include familiar names like Hydroxycut, Oxy ELITE Pro and LipoKinetix.

Green tea extract, or GTE, is derived from unfermented leaves of the Chinese tea tree, Camellia sinensis. One of the active ingredients in GTE is epigallocatechin gallate, which is a catechin, or a compound that is abundant in teas, cocoa products and certain berries. It boasts purported weight-loss properties by stopping fat-causing lipogenic enzymes.

While the public tends to view HDS products as safer than most conventional medications because they are derived from plants and other “natural sources,” this is not always the case, Fontana says.

“Various animal studies have shown the hepatotoxic (and possibly deadly) potential of GTE,” he says. “Extreme levels of GTE will lead to elevated aminotransferase (enzymes) in mice that significantly reduce their survival rates.”

Further, the Drug-Induced Liver Injury Network reported a study in which six patients who took GTE-containing Slimquick weight-loss products suffered hepatocellular injury, while four of the six were also severely jaundiced. Additionally, three patients from this group were hospitalized, and one had to have a liver transplant.

Hydroxycut hepatotoxicity

The first reported incidents of hepatotoxicity attributed to ephedra-containing Hydroxycut involved 12 patients in the U.S. who developed severe hepatitis after consuming supplements. Of the patients, 75 percent were female, with a mean age of 38.

It took an average of just eight weeks for an individual to develop hepatocellular injury after taking Hydroxycut.

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Eight of these patients recovered from their liver damage, while three underwent liver transplantation, Fontana says. One patient died before transplantation.

At least 17 additional cases of Hydroxycut-associated liver injury have been reported with similar phenotypes of liver injury and outcomes. And in 2004, the FDA banned the sale of supplements containing ephedra.

In May 2009, the FDA published a warning about Hydroxycut-related hepatotoxicity, resulting in withdrawal of 14 Hydroxycut products from the market.

“Without regulations like standardized chemical analyses and product manufacturing guidelines, it is nearly impossible to determine the exact chemical makeups for these types of supplements,” Fontana says. “And that just adds another element of danger to consuming them.” 


Fontana has received research grants from AbbVie, Gilead Sciences and Bristol-Myers Squibb. He also provides consulting services for Alnylam Pharmaceuticals.
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Friday, January 11, 2019

Three-part series: What’s the Difference: Hepatitis B vs Hepatitis C?

Hepatitis B Foundation


With five different types of viral hepatitis, it can be difficult to understand the differences between them. Some forms of hepatitis get more attention than others, but it is still important to know how they are transmitted, what they do, and the steps that you can take to protect yourself and your liver!

This is part one in a three-part series. 
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Thursday, November 22, 2018

Blogging About Liver Disease: Reasons To Be Grateful


Happy Thanksgiving! This year, and every year, I am grateful for a small group of talented bloggers who continue to keep us informed about all types of viral hepatitis.

In the spirit of the holiday, each blog has featured many reasons to be thankful this year; from curing HCV to improving the treatment of HIV.

Latest Articles 
Some of the following blogs are published by support organizations, healthcare professionals or physicians, while others are written from a patients perspective, offering us healthy tips about each stage of liver disease.

New @ HIV and ID Observations
Paul E. Sax, MD
As noted here before, I’m a big fan of Thanksgiving, a great excuse to get together with family and friends, and to eat a gargantuan amount of food.*

 Hepatitis B Foundation
Holidays with Hepatitis B: How to Tell Your Family
hepbtalk
As the holidays approach, families are planning parties and dinners and preparing to spend time with their loved ones. In such a merry atmosphere, the idea of discussing hepatitis B – whether its a recent diagnosis or the first time that you are ready to disclose your status – may be intimidating. However, it doesn’t have to be! In honor of National Family Health History Day – which falls on Thanksgiving – we put together some tips to help you start the conversation.

 Joseph Galati, M.D.
Tips for a Healthier Holiday
Ahh, the holidays. A time to celebrate all the good that has come our way during the previous year. First up: Thanksgiving. What better way to begin the year-end wrap-up than to sit down at a hearty meal with family and friends? But the holidays are arguably the toughest time of the year to eat..

Hep Blogs
Finding Gratitude in Sickness, Health and Hepatitis 
By Lucinda K. Porter, RN
Some good news in the hepatitis C realm, plus a look at the practice of gratitude.

Mavyret versus Epclusa
By Greg Jefferys
Both Mavyret and Epclusa give cure rates above 97% for all genotypes of Hepatitis C except for G3 where both give a cure rate of around 95%.

The End Times
By Grace Campbell
Who gave cirrhosis such a catchy generic title? End stage liver disease. There’s a name sure to invoke confidence.

Liver Meeting 2018 Wrap-Up: Vaccines, Diet, and an Increasing Liver Menace 
By Lucinda K. Porter, RN
Ending the week with summaries of research from the 2018 Liver Meeting. I cover hepatitis B vaccination, diet and alcoholic liver disease.

 HepatitisC.net
Options for Treatment with Liver Cancer
By Karen Hoyt
After my diagnosis of liver cancer, I had to find out what options for treatment were available.

 ADRLF (Al D. Rodriguez Liver Foundation)
Who says a fantastically delicious Thanksgiving spread can’t be healthy? This year, make your Thanksgiving feast even more special with these liver-healthy options that won’t give you or your family that post-holiday guilt; nor will they keep you stuck in the kitchen for hours on end! Check out these appetizing recipes for a healthy, scrumptious, easy-to-prep (or time-saving) Thanksgiving meal!

Finding Hope in Affordable Hepatitis Screening
Screening remains to be the best defense against detecting the hepatitis virus in its earliest stages, and potentially developing life-threatening complications, later down the line. Dubbed as the “silent killer,” hepatitis doesn’t exhibit obvious symptoms in many people, who may live, comfortably, with the virus for years and only discover their condition at its advanced, acute stage. Noting the importance of the timeliness of testing, Texas-based Link2Labs is making affordable hepatitis C tests available to uninsured and underinsured people.

HCV News
Weekly Review
Catch up on what you missed this week, read HepCBC's - Weekly Bull.

 FYI - Lettuce Recall 
“I believe it’s all related to a big increase in obesity and type 2 diabetes in this country,” lead study author Zobair M. Younossi, MD, MPH, said in an interview in advance of the annual meeting of the American Association for the Study of Liver Diseases. “Those two risk factors drive NAFLD and its progressive type, nonalcoholic steatohepatitis (NASH). That accounts for at least part of the increase in mortality related to liver disease.”

AGA Journals - Blog
Dr. Kristine Novak
Persistent drinking of very hot coffee can cause exfoliative esophagitis due to thermal injury, researchers report in the November issue of Clinical Gastroenterology and Hepatology. Florian Schertl et al describe the case of a 55-year-old woman with new retrosternal pain upon swallowing. She had been receiving continuous and successful proton pump inhibitor.

 Fatty Liver Disease
Canadian Liver Foundation
It Happened To Me | My Fatty Liver Journey
Melanie was all too familiar with fatty liver disease, with her husband being diagnosed 5 years earlier. But, she never thought it would happen to her.

 The Flu & You
Canadian Liver Foundation
What’s intended to help shouldn’t hurt
Before you head to the cabinet for medication, there are a few things you should know to ensure that what you take will help, not hurt.

One Medical blog
So you’ve come down with a nasty bug that’s been making the rounds.

This Blog
Flu Activity Updated Nov 10/News Articles Nov 16
Weekend Reading - Baby Boomers and the Flu

Recommended Blogs
Dr Paul Gow talks all things the liver and answers call-in questions on ABC Nightlife 


Source - Hepatitis Victoria

On Twitter
Shared by @HenryEChang 

Just Because
Matthew Kaskavitch
CU Anschutz Medical Campus experts share Thanksgiving health insights
Thanksgiving is almost here, and that means two things: 1) time spent with family and friends around the television watching football, and 2) eating turkey. Lots and lots of turkey. At this time of year, we often overindulge and loosen our belt and wonder how we fit all that stuffing and gravy into our stomach. Don’t worry. We asked leading health experts from the University of Colorado Anschutz Medical Campus a few of the Thanksgiving questions you’ve always wanted to know the answer to.

Happy Thanksgiving!
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Wednesday, October 24, 2018

'The food supplement that ruined my liver'

BBC
'The food supplement that ruined my liver'
Tristan Quinn
It should have been one of the happiest days of his life. But Jim McCants looks back on his youngest son's high school graduation with mixed emotions. As he sat down next to his wife Cathleen in the university auditorium, just outside Dallas, Texas, she turned to look at him.

"She said 'Do you feel OK?'" Jim recalls. "I said, 'Yeah I feel fine, why?' 'Your face is yellow, your eyes are yellow, you look terrible.' When I looked in the mirror it was shocking."
Read More: https://www.bbc.com/news/stories-45971416

On This Blog
Current articles investigating herbal and dietary supplement-induced liver injury 
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Wednesday, October 17, 2018

Combination immunotherapy may increase liver injury risk

Combination immunotherapy may increase liver injury risk
October 17, 2018
PHILADELPHIA – Patients who received treatment with multiple immunotherapy drugs had increased risks for drug-induced liver injury compared with single therapy courses, as presented at the American College of Gastroenterology Annual Meeting.

“This is a rather new subsection of drug-induced liver injury that has come to our attention since the advent of immunotherapy drugs in the treatment of various different cancers, ranging from metastatic melanoma ... to colorectal cancer and renal cell carcinoma,” Vivek Bose, MD, from the Rutgers Robert Wood Johnson Medical Group in New Jersey, said during his presentation. 

Healio Meeting Coverage
See more from American College of Gastroenterology Annual Meeting

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Wednesday, September 26, 2018

Heavy drinkers and teetotalers alike may have heightened dementia risk

Of Interest
Alcohol use disorder therapy could improve chronic liver disease outcomes
Fuster D, Samet JH. N Engl J Med. 2018;doi:10.1056/NEJMra1715733.
September 26, 2018
Details from a recently published review discussed expanded use of alcohol use disorder medications and treatments in everyday clinical practice for patients with advanced liver disease.

In HCV, alcohol use increases infection exposure and persistence, causes more extensive liver damage than the infection alone, leads to faster progression of liver fibrosis and results in higher rates of mortality. These effects are common in HBV as well, although alcohol use in patients with HBV also demonstrated an increased risk for hepatocellular carcinoma.

Along with increased fibrosis progression and an increased risk for hepatocellular carcinoma, alcohol use in patients with NAFLD leads to a greater prevalence of steatosis and abnormal liver tests. In hereditary hemochromatosis, alcohol use increases fibrosis progression as well as iron overload.

“Assessment of alcohol use is appropriate for any person with liver disease, given the elevated risks of alcohol-related hepatotoxicity,” Fuster and Samet wrote. “In fact, there is no known safe threshold of alcohol consumption for patients with chronic liver disease, especially those with HCV infection, obesity, or the metabolic syndrome.”


Heavy drinkers and teetotalers alike may have heightened dementia risk 
Lisa Rapaport
(Reuters Health) - Middle-aged adults who avoid alcohol altogether, and those who consume the equivalent of seven glasses of wine or more a week are both more likely than light drinkers to develop dementia in their later years, a long-term study suggests.

Abstinence is also associated with a higher likelihood of having heart disease or diabetes, which explains part of the increased dementia risk for teetotalers, the study found. Abstinence may also be tied to dementia in people who stopped drinking due to misuse or addiction, Sabia said by email...

“Findings on abstainers should not motivate people who do not drink to start drinking alcohol due to the adverse effects of alcohol on mortality, cirrhosis of the liver and cancer,” Sabia noted. “In addition, given the detrimental effect of alcohol for several health outcomes, people who drink in an excessive manner should be encouraged to reduce their alcohol consumption.” 

Recommended Reading
Alcohol abuse kills 3 million a year, most of them men: WHO
Of all deaths attributable to alcohol, 28% were due to injuries, such as those from traffic crashes, self-harm and interpersonal violence; 21% due to digestive disorders; 19% due to cardiovascular diseases, and the remainder due to infectious diseases, cancers, mental disorders and other health conditions...
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Study: Damaged liver cells undergo reprogramming to regenerate

Study: Damaged liver cells undergo reprogramming to regenerate
Sep 26, 2018 8
by Steph Adams | Science Writer

The Greek hero Prometheus was punished by being lashed to a rock and having his liver eaten each day by an eagle, a myth that hints at the extraordinary regenerative powers of the human liver. A new study offers insight into how RNA splicing generates alternate forms of the “Hippo signaling pathway” to promote liver regeneration.

Graphic by Jose Luis Vasquez, Beckman Institute

CHAMPAIGN, Ill. — In Greek mythology, Zeus punishes the trickster Prometheus by chaining him to a rock and sending an eagle to eat a portion of his liver every day, in perpetuity. It was the right organ to target – the liver has the ability to regenerate itself, though not overnight nor for eternity.

New research conducted by biochemists at the University of Illinois has determined how damaged liver cells repair and restore themselves through a signal to return to an early stage of postnatal organ development. The findings are reported in the journal Nature Structural & Molecular Biology.

“The liver is a resilient organ,” said U. of I. biochemistry professor Auinash Kalsotra, who led the new research. “It can restore up to 70 percent of lost mass and function after just a few weeks.

“We know that in a healthy adult liver, the cells are dormant and rarely undergo cell division,” he said. “However, if the liver is damaged, the liver cells re-enter the cell cycle to divide and produce more of themselves.”

The human liver can become chronically damaged by toxins such as alcohol and even certain medicines, but still continue to function and self-repair, Kalsotra said.

“This research looked at what is happening at the molecular level in a damaged liver that enables it to regenerate while still performing normal functions,” he said.

Using a mouse model of a liver severely damaged by toxins, the researchers compared injured adult liver cells with healthy cells present during a stage of development just after birth. They found that injured cells undergo a partial reprograming that returns them to a neonatal state of gene expression.

The team discovered that fragments of messenger RNA, the molecular blueprints for proteins, are rearranged and processed in regenerating liver cells in a manner reminiscent of the neonatal period of development. This phenomenon is regulated through alternative splicing, a process wherein exons (expressed regions of genes) are cut from introns (intervening regions) and stitched together in various combinations to direct the synthesis of many different proteins from a single gene. These proteins can have different cellular functions or properties.

“We found that the liver cells after birth use a specific RNA-binding protein called ESRP2 to generate the right assortment of alternatively spliced RNAs that can produce the protein products necessary for meeting the functional demands of the adult liver,” said graduate student Sushant Bangru, the lead author of the study. “When damaged, the liver cells lower the quantity of ESRP2 protein. This reactivates fetal RNA splicing in what is called the ‘Hippo signaling pathway,’ giving it instructions about how to restore and repopulate the liver with new and healthy cells.”

Kalsotra described the science in mythological terms: “When Zeus’ eagle comes in for its daily snack, damaging the liver, the alternatively spliced form of Hippos come into play – repairing Prometheus’s liver so the poor guy can go through this whole punishment again the next day.”

The National Institutes of Health, March of Dimes and American Heart Association supported this
research.

The paper “Alternative splicing rewires Hippo signaling pathway in hepatocytes to promote liver regeneration” is available online and from the U. of I. News Bureau.
DOI: 10.1038/s41594-018-0129-2

https://news.illinois.edu/view/6367/698670

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Blood flow forces liver growth

NEWS AND VIEWS
26 September 2018

Blood flow forces liver growth
Sina Y. Rabbany & Shahin Rafii
Increases in biomechanical forces in the liver’s blood vessels have now been shown to activate two mechanosensitive proteins. The proteins trigger blood-vessel cells to deploy regenerative factors that drive liver growth. 

The molecular pathways that initiate and sustain liver growth during development and after injury are orchestrated in part by a balanced supply of stimulatory and inhibitory factors secreted from specialized liver sinusoidal endothelial cells (LSECs), which line the organ’s blood vessels1–4. But it is unclear how the liver vasculature senses the need to produce these endothelial-cell-derived (angiocrine) growth factors, such as hepatocyte growth factor (HGF) and Wnt proteins, to guide proper organ growth4. In a paper in Nature, Lorenz et al.5 show how mechanical forces created by the passage of blood through the liver activate signalling pathways that promote the production of angiocrine factors and the proliferation of the organ’s main cell type, hepatocytes, in mice.

Continue reading online @ Nature
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Monday, September 24, 2018

What Is a Healthy Stool ?

Of Interest - posted Feb 2018:
Clinical Gastroenterology and Hepatology (CGH)
February 2018 Volume 16, Issue 2, Page A22
What Causes Constipation?
Constipation is usually a symptom, not a disease. Some of the most common causes of constipation are as follows....

What Does My Stool Color Or Change In Bowel Movement Mean?
On this page an overview of stool color changes due to either medications, diet, or indicate an underlying medical condition such as gallstones and liver disease is explored. For instance according to a recent article published 21 September 2018 online at Medical News Today, a yellow stool may indicate problems with the pancreas, liver, or gallbladder.

Further down this page is the famous Bristol Stool Scale, developed by UK gastroenterologists at the University of Bristol. The chart explains various stool types by identifying physical attributes and the length of time the stool remained in the colon.

What Is a Healthy Stool ?

Stool Color Overview
Stool starts out green , then turns bright yellow as it goes through the digestive tract. It is bile and bacteria that finally turn it brown. Yellow or green stools can indicate stool is passing through the digestive tract too rapidly not giving it a chance to change colour. Bright yellow stools can also indicate not enough bile / bilary obstruction.

The color of stool normally is brown. The reason for the brown color is the presence of bile in the stool. Bile is made by the liver, concentrated and stored in the gallbladder, and secreted into the intestine to aid in the digestion of food. Depending on the amount of bile it contains, the normal stool color can range in color from light yellow to almost black.


Bile secreted from the gallbladder into the intestine is a very dark green liquid made up of many chemicals, one of which is bilirubin. When red blood cells are destroyed naturally in the body, the hemoglobin, a protein inside the red blood cells that carries oxygen, is modified in the liver. The by-product of this process is bilirubin, and the liver secretes the bilirubin into bile.

As the bile travels through the intestines, it can undergo further chemical changes, and its color can also change. For example, if the traveling time through the intestine is too rapid, then bile would not have the time to go through additional color changes and the stool color may be close to green.

The color of stool can change for other reasons as well. Many changes in stool color may not be of much importance, especially if the change happens once and is not consistent from one stool to the next. Sudden major changes in stool color that persist may suggest an underlying medical problem.

Furthermore, gradual but persistent changes in stool color also can signify medical problems.

Some of the important colors of stool that can signify problems include:
red,
maroon,
black,
clay-colored,
pale, orange, and
yellow.

Stool Color Changes Causes
Stool color can change for a variety of reasons. Some stool color changes may signify an underlying medical condition, and others may be due to ingestion of food or medications.

 Dark Colored Stools
Dark-colored stools may be seen in platelet function disorders, iron deficiency anemia, cirrhosis, colorectal cancer, disseminated intravascular coagulation, peptic ulcer, or stomach cancer. Liver disease may include a yellow tone to the skin and whites of eyes (jaundice) and brownish urine.

Black Tarry, Sticky Stools
Bleeding in the stomach or the intestines can change the color of stool. If bleeding occurs in the stomach or the upper part of the small intestine, the stool may turn black and sticky, described medically as black, tarry stool. Generally, black, tarry stool also is foul-smelling. This change in color and consistency occurs because of chemical reactions to blood within the intestine that are caused by digestive enzymes within the intestines.

Maroon or Red Stools
Red or maroon colored stools can also mean the presence of blood in your stools; in the medical field this condition is called hematochezi.

The difference between this color and the black or tarry color is the location of the bleeding. A red or maroon colored stool usually indicates a fresher blood and therefore lower GI bleeding.

Black color
bleeding ulcer,  gastritis, esophageal varices, a tear in the esophagus from violent vomiting

Maroon color-all the causes of black color stool
diverticular bleeding
vascular malformation
intestinal infection (such as bacterial enterocolitis)
inflammatory bowel disease, tumor, colon polyps or colon cancer

Bright red color
all the causes of black or maroon color stool
hemorrhoids
anal fissures (cracks in the anal area)

Not all red colored stools are caused by bleeding, as some foods can have the same effect. If you have recently consumed red colored gelatin, popsicles, Kool-Aid, tomato juice, soup and/or beets, you may experience reddish stools

Black Stools (Not Sticky, No Odor)
Other causes of black stool are iron pills or bismuth-containing medications (such as, bismuth subsalicylate or Pepto Bismol). If the stool color is dark because of any of these medications, it is typically not sticky in texture and is not foul-smelling .

Gray or Clay-Colored Stool
Hepatitis and gallbladder disorders
Stool can be gray or clay-colored if it contains little or no bile. The pale color may signify a condition (biliary obstruction) where the flow of bile to the intestine is obstructed, such as, obstruction of bile duct from a tumor or stone.

A stool that appears clay in color is often seen in cases of mal-absorption, hepatitis, or gallbladder disorders.

Hepatitis and gallbladder disorders often interrupt the flow of bile out of the liver. This disruption will cause the clay color of the stool. Mal-absorption also disrupts the output of bile by increasing the amount of undigested fat in the stool. Bile is responsible for breaking down stool and making it brown in color. When the production is lowered the stool can appear clay in color.

Yellow Stool
Stool that is yellow may suggest presence of undigested fat in the stool.

This can happen as a result of diseases of pancreas that reduce delivery of digestive enzymes to the intestines, such as chronic pancreatitis (long standing inflammation and destruction of the pancreas usually due to alcohol abuse) or obstruction of the pancreatic duct that carries the enzymes to the intestines (most commonly due to pancreatic cancer).

The digestive enzymes released from the pancreas and into the intestines are necessary to help digest fat and other components of food (proteins, carbohydrates) in the intestines so that they can be absorbed into the body.

If the pancreas is not delivering enzymes into the intestines, then components of food, especially the fat, can remain undigested and unabsorbed. The stool containing the undigested fat may appear yellowish in color, greasy, and also smell foul.

Stool Color Changes Symptoms
The symptoms associated with changes in the color of stool generally correspond to the underlying cause (although the presence of large amounts of blood alone may lead to diarrhea and possibly cramping). In many instances, there may not be any symptoms associated with changes in the color of stool.

Bleeding from the gastrointestinal tract (esophagus, stomach, small intestine, large intestine) leading to red, maroon, or black tarry stools may be without any symptoms at all or may have accompanying symptoms of abdominal pain due to the underlying cause of the bleeding, for example, an ulcer;
nausea, vomiting of blood, diarrhea, and cramping due to the presence of blood in the stomach and/or intestines; and weakness, lightheadedness, and dizziness, due to the loss of blood from the body.

Persistently gray or clay-colored stools suggest some type of obstruction to the flow of bile. Obstruction caused by gallstones usually is associated with pain on the right side of the abdomen. However, cancer of the bile duct or cancer of the head of pancreas, which also can cause obstruction to the flow of bile by pressing on the bile duct, may not be associated with abdominal pain unless the tumor is large. The obstruction to the flow of bile causes backup of bile into the blood resulting in yellowness of skin and eyes that is referred to as jaundice.

Yellow stool as a result of undigested fat also may occur with no symptoms. If present, the most common symptom associated with yellow stool will be abdominal pain as a result of chronic pancreatitis, tumor of the pancreas, or obstruction of the pancreatic duct.

Orange Stool
If your stool shows orange coloring, it can usually be attributed to foods or medications that you may be taking. Certain medications with beta-carotene (such as a form of vitamin A) can cause orange coloring of your stool. Antacids which contain aluminum hydroxide can also cause orange stool.

Foods that are high in beta-carotene can have the same orange effect on your stool. These include; carrots, sweet potatoes, kale, spinach, turnip greens, winter squash, collard greens, cilantro and fresh thyme. Lastly any foods that have yellow or orange artificial colorings can also cause orange colored stool.

If you can not attribute your orange stool with anything you ingested, then it may be caused by a lack of exposure to bile salt. Stool starts out as green, and then turns to a yellow-orange in color before being exposed to bile and bacteria which turns the stool brown.
Low exposure to bile salt can be caused by a couple different factors. First, your transit time is so fast that your stool is being pushed through your digestive system too quickly. This quick movement of stool reduces the exposure to bile salt resulting in orange stool.

Diarrhea
The passage of an increased amount of stool. This is frequently considered to be 3 or more stools per day, or excessively watery and unformed stool. Chronic diarrhea occurs when loose or more frequent stools persist for longer than two weeks.

Diarrhea causes can be grouped into several general categories.
Infections
 viruses
bacteria
parasites
Toxins often referred to as food poisoning. Toxins may be produced in foods as bacteria grow.

These toxins are responsible for the associated vomiting and diarrhea.
Malabsorption
lactose intolerance
celiac disease (sprue) or gluten malabsorption,
cystic fibrosis
cows milk protein intolerance
intolerance to specific foods (beans, fruit, etc.)

There are other less frequently encountered causes of malabsorption.
Inflammatory Diseases of the Bowel
Crohns disease, ulcerative colitis

Immune deficiency
Medications
antibiotics, laxatives (especially those containing Magnesium), chemotherapy
Other

Floating stools
Stools that float are generally associated with some degree of malabsorption of foods or excessive flatus/gas. Floating stool is seen is a variety of different situations, the majority being diet-related or in association with episodes of diarrhea caused by an acute gastrointestinal infection. A change in dietary habits can lead to an increase in the amount of gas produced by bacteria in the gastrointestinal tract.

Similarly, acute gastrointestinal infections can result in increased air/gas content from rapid movement of food through the GI tract. One misconception is that floating stools are caused by an increase in the fat content of the stool.

In fact, increased air/gas levels in the stool make it less dense and allow it to float. Another cause of floating stools is malabsorption. More than two weeks of diarrhea with floating stools is often seen in people suffering from malabsorption, a dysfunction in the GI tract that affects the bodys ability to digest and absorb fat and other food. Increased levels of nutrients in the stool (those not absorbed by the GI tract) are supplied to the normal bacteria that live in the gut, which in turn produce more gas. This results in more air/gas- rich stool that floats.

Dietary changes, diarrhea, and malabsorption can cause floating stools. Most causes are benign and will resolve when the infection ends or the bacteria in the GI tract become accustomed to the changes in your diet.

Stinky stools
Stools normally have an unpleasant odor, but one that is recognized as fairly common or typical. Stools that have an extremely bad, out- of-the-ordinary odor may be associated with certain medical conditions.

Foul-smelling stools also have normal causes, most notably diet. Foul smelling stools may occur in conjunction with floating stools.

Extremely foul smelling stools can be due to bacteria overgrowth. Some bacteria produce hydrogen sulfide which has a characteristic rotten egg smell (horrible stench).

It can also be the putrifying debris in the gut. Ammonia smelling stools can be attributed to bacteria overgrowth or nitrogen being insufficiently digested or improperly metabolized.

When food is insufficiently digested, the non-absorbed food can then become food for harmful bacteria, or just putrefy, in the gut. Either of these leads to toxins being released in the body.
Sulfur smell a few people noted that if they eat more sulfur containing foods and have a yeast problem, the yeast may feed on the sulfur foods and get worse.

These cases also say an increase in yeast with sulfur supplements. Other supplements reported to produce a smell when not absorbed and metabolized well are selenium, glutathione, and SAMe.
Besides smelly stools, a person many have bad body odor and bad breathe even shortly after taking a shower or brushing teeth.

When to Seek Medical Care
Individuals should notify their physician when there is a persistent change in the color of their stool.

Persistent black, tarry stools or red, bloody stools signify intestinal bleeding and need to be evaluated by a physician promptly. Individuals should either notify their primary care doctor or visit an urgent care center or emergency room.

Gray or clay-colored stool and yellow stool also may signify diseases of the pancreas, gallbladder, or the liver. The evaluation of these conditions may warrant careful evaluation by an internist, primary care physician, or a gastroenterologist (a physician specialized in disease of the stomach and the intestines).

Exams and Tests
The evaluation of changes in stool color typically begins with a thorough physical examination and personal medical history. The doctor may ask about intake of alcohol, smoking, and other habits. Family history of any cancers, particularly of the liver or pancreas or bleeding problems may be helpful. A review of medications that may affect the color of stool, including over-the-counter (OTC) medications, also is important. Any changes in bowel habits (constipation, diarrhea, and change in frequency) or any pertinent symptoms (pain with or without eating, nausea, vomiting, weight loss, etc.) can provide valuable clues in evaluating the underlying causes of changes in stool color.

Diagnostic testing to find the cause of changes in stool color typically start with simple blood tests including complete blood count (CBC), chemistries, liver enzymes (comprehensive metabolic panel or CMP or SMA 19), and blood clotting (coagulation). These tests can demonstrate anemia, liver disease, gallbladder disease, or other underlying conditions that may be responsible for the changes in stool color. Pancreatic enzymes amylase and lipase also can be measured to determine if pancreatic disease is present.

If bleeding from the stomach or intestines is suspected but the stool is not visibly black, red or maroon, occult blood (a small amount of blood that does not cause the color of stool to change much) can be sought by testing the stool directly for blood with a dye (fecal occult blood test or FOBT). This test relies on a chemical reaction between a solution (called guaiac) and hemoglobin in a sample of stool. In the presence of hemoglobin, the drop of solution will turn the stool sample (smeared onto a special paper which reacts chemically with the solution) blue. This test is part of the recommendation for screening for colon cancer, although in clinical practice, it is often used to determine if any bleeding is occurring in the gastrointestinal system. In addition to the test using guaiac, there is an immunological test for blood in the stool that uses an antibody to hemoglobin to detect the blood.

Methods to evaluate a change in the color of stool are upper gastrointestinal endoscopy (esophago-gastro-duodenoscopy or EGD) and colonoscopy. These tests are done by gastroenterologists to look inside the esophagus and stomach (EGD) and the colon (colonoscopy) with a video camera to detect the source of the bleeding or other abnormality that may explain the change in stool color. If necessary, biopsies can be taken with these techniques.

More advanced endoscopic testing to look for obstruction of the biliary or pancreatic ducts is called an endoscopic retrograde cholangio-pancreatography or ERCP. This test is performed like an EGD except that during the test dye is injected into the bile and pancreatic ducts to look with X-rays for obstruction of the ducts.

Other imaging studies sometimes are necessary in order to find the cause of the change in stool color. Computerized tomography (CT scan) is ordered frequently by physicians if the change in stool color is believed to be related to underlying cancer, pancreatic disease, or obstructive conditions of the bile ducts and gallbladder. Ultrasound of the abdomen is a frequently used, relatively inexpensive and reliable test to evaluate for gallstones or blockage of the gallbladder. Magnetic resonance imaging (MRI) of the abdomen sometimes is done to look more closely at any obstructive disease of the biliary or pancreatic ducts.

Stool Color Changes Treatment
The treatment for changes in stool color depends on the cause. As described earlier, some changes in the color of stool can be due to the color of the ingested food. Other more important medical causes may require simple or extensive medical evaluation and treatment.

Self-Care at Home
As for self care, it is important to recognize whether the change in stool color is persistent, recurrent or transient. Generally, changes in stool color that are transient, for example, once or twice, and then return to normal are not as important as persistent or recurrent changes.

Some of the symptoms associated with changes of stool color also are important to recognize. For example, if the stool is red, maroon or black, signifying bleeding from the intestines, then symptoms of abdominal pain, lightheadedness, or dizziness (from losing too much blood) may prompt someone to seek medical care more urgently.

Medical Treatment
Medical treatment for change in stool color can vary widely depending on what the cause is.

Some common scenarios include gastrointestinal bleeding resulting in red, maroon, or black looking stool. In most cases, these are dealt with by gastroenterologists either in their office or in a hospital setting. Depending on the patients description, physical examination, medical history, and results of diagnostic testing, the doctor may decide to treat with medications for stomach ulcers or inflammation in the stomach or the intestines.

In some situations, a specific treatment may not be available for certain types of bleeding, and the patient may only be asked to stop taking medications that can promote further bleeding (aspirin or nonsteroidal antiinflammatory drugs [NSAIDS]).

Sometimes medications are injected into the sites of the bleeding during endoscopic evaluations to help stop the bleeding. In rare situations where bleeding continues despite aggressive medical care, radiologists may pass catheters through the arteries and inject the smaller arteries that are feeding the site of bleeding with chemicals or beads to reduce the bleeding. Surgery may be required to remove part of the intestine that is the site of bleeding.

Clay-colored or gray stools also are evaluated by gastroenterologists as well as surgeons. If the change in color is caused by a stone obstructing the bile or pancreatic duct, the gastroenterologist sometimes can remove the stone by performing an ERCP. In other cases, surgery may be necessary to remove a stone or a tumor.

Next Steps
Follow-up
Change in stool color can be followed based on the cause and based on recommendation of the treating doctor.

Prevention
Prevention of change in stool color may be meaningless without knowing the cause. Since stool color can change for a variety of reasons, any preventive measure for the cause may play a role in preventing further changes in stool color.

For example, if the stool is black and tarry because of a bleeding ulcer, then avoiding medications that can cause bleeding, such as aspirin, may be a reasonable preventive measure. Avoiding alcohol can be a preventive measure against yellow stools resulting from undigested fat in stool due to pancreatic disease.

On the other hand, some causes of changes in the color of stool, for instance, cancer of the pancreas, may not be preventable.

Outlook
The outlook for changes in stool color varies with the underlying cause. For example, many causes of bleeding from the stomach or the intestines are benign, such as ulcers, and generally carry good prognoses while bleeding due to a cancer carries a less favorable diagnosis.

Author and Editor
Author: Saimak T. Nabili, MD, MPH
Editor: Jay W. Marks, MD
REFERENCE: MedicineNet.com.

What causes undigested food to appear in stool?
Last reviewed Wed 9 May 2018
By Jenna Fletcher
When undigested food in the stool is accompanied by another change in bowel habits, weight loss, or diarrhea, this may signal an underlying condition that needs medical attention. In this article, we look at the various causes for undigested food to appear in stool and when a person should see their doctor.

The Bristol Stool Scale
The Bristol Stool Scale was developed in the United Kingdom by a small team of gastroenterologists at the University of Bristol. It is designed to be a representative explanation for stools commonly seen in toilet water. In the different categories, the chart explains the correlation between the stool's physical attributes and the length of time the stool remained in the colon.

This scale is useful to anyone who would like to determine the condition of their colon because it is a generic indicator; it is not an absolute diagnostic tool. It is, however, a good indicator of what action you may need to take. Below are the chart and the analysis for your use at home.

Type 1: Separate hard lumps, like nuts
Typical for acute disbacteriosis. These stools lack a normal amorphous quality, because bacteria are missing and there is nothing to retain water. The lumps are hard and abrasive, the typical diameter ranges from 1 to 2 cm  0.4 to 0.8 inches and they are painful to pass, because the lumps are hard and scratchy. There is a high likelihood of anorectal bleeding from mechanical laceration of the anal canal. Typical for post-antibiotic treatments and for people attempting fiber-free (low-carb) diets. Flatulence is not likely, because fermentation of fiber is not taking place

Type 2: Sausage-like but lumpy
Represents a combination of Type 1 stools impacted into a single mass and lumped together by fiber components and some bacteria. Typical for organic constipation. The diameter is 3 to 4 cm 1.2 to 1.6 inches. This type is the most destructive by far because its size is near or exceeds the maximum opening of the anal canals aperture ( 3.5 cm ). It is bound to cause extreme straining during elimination, and most likely to cause anal canal laceration, hemorrhoidal prolapse, or diverticulosis. To attain this form, the stools must be in the colon for at least several weeks instead of the normal 72 hours. Anorectal pain, hemorrhoidal disease, anal fissures, withholding or delaying of defecation, and a history of chronic constipation are the most likely causes. Minor flatulence is probable. A person experiencing these stools is most likely to suffer from irritable bowel syndrome because of continuous pressure of large stools on the intestinal walls. The possibility of obstruction of the small intestine is high, because the large intestine is filled to capacity with stools. Adding supplemental fiber to expel these stools is dangerous, because the expanded fiber has no place to go, and may cause hernia, obstruction, or perforation of the small and large intestine alike.

Type 3: Like a sausage but with cracks in the surface
This form has all of the characteristics of Type 2 stools, but the transit time is faster, between one and two weeks. Typical for latent constipation. The diameter is 2 to 3.5 cm  0.8 to 1.4 inches. Irritable bowel syndrome is likely. Flatulence is minor, because of disbacteriosis. The fact that it has not became as enlarged as Type 2 suggests that the defecations are regular. Straining is required. All of the adverse effects typical for Type 2 stools are likely for type 3, especially the rapid deterioration of hemorrhoidal disease.

Type 4: Like a sausage or snake, smooth and soft
This form is normal for someone defecating once daily. The diameter is 1 to 2 cm  0.4 to 0.8 inches. The larger diameter suggests a longer transit time or a large amount of dietary fiber in the diet.

Type 5: Soft blobs with clear-cut edges
I consider this form ideal. It is typical for a person who has stools twice or three times daily, after major meals. The diameter is 1 to 1.5 cm  0.4 to 0.6 inches .

Type 6: Fluffy pieces with ragged edges, a mushy stool
This form is close to the margins of comfort in several respects. First, it may be difficult to control the urge, especially when you do not have immediate access to a bathroom. Second, it is a rather messy affair to manage with toilet paper alone, unless you have access to a flexible shower or bidet. Otherwise, I consider it borderline normal. These kind of stools may suggest a slightly hyperactive colon (fast motility), excess dietary potassium, or sudden dehydration or spike in blood pressure related to stress (both cause the rapid release of water and potassium from blood plasma into the intestinal cavity). It can also indicate a hypersensitive personality prone to stress, too many spices, drinking water with a high mineral content, or the use of osmotic (mineral salts) laxatives.

Type 7: Watery, no solid pieces
This, of course, is diarrhea, a subject outside the scope of this chapter with just one important and notable exception so-called paradoxical diarrhea. It is typical for people (especially young children and infirm or convalescing adults) affected by fecal impaction a condition that follows or accompanies type 1 stools. During paradoxical diarrhea the liquid contents of the small intestine (up to 1.5  to 2 liters/quarts daily) have no place to go but down, because the large intestine is stuffed with impacted stools throughout its entire length. Some water gets absorbed, the rest accumulates in the rectum. The reason this type of diarrhea is called paradoxical is not because its nature is not known or understood, but because being severely constipated and experiencing diarrhea all at once, is, indeed, a paradoxical situation. Unfortunately, it is all too common.

5 Things Your Poop Can Tell You About Your Health​

​Ever curious what bowel changes could signal about your health?
Poop may be a gross topic that no one likes to talk about, but taking a quick peek before you flush may give you clues about your health. Having a bowel movement is a critical part of digesting the food we eat. Stool formed by the large intestine is the body’s way of getting rid of waste.

While you should talk to your doctor about any concerns, changes in poop color and consistency could show what is happening inside your digestive system.

1. Rocks and Pebbles
Poop that is hard and shaped like tiny rocks or pebbles is likely just a sign of constipation. You can still be considered constipated even if you are able to pass a small amount of stool.
The large intestine helps to concentrate waste by absorbing water. If muscle contractions in the large intestine are not working properly, waste left in the colon becomes even more concentrated, resulting in harder stool.

2. Color Changes
“One of the most common concerns I hear from patients is worry about the change of poop color,” says Dr. Linda Lee, director of the Johns Hopkins Integrative Medicine and Digestive Center. The color of stool is impacted by the foods you eat and the kind of bacteria living in your colon.
“There are a lot of food colorings added to what we eat and drink, so of course the color of your stool is then going to change,” says Lee. “When I perform a colonoscopy, I can actually tell what color the beverage was they used to take the prep.”
A change in the color of stool is usually not cause for concern, unless it appears to be black or bloody, which could signal other problems with the digestive system.

3. Black and Tarry
The most common cause of black and tarry poop is from taking iron supplements or a medication containing bismuth, such as Pepto-Bismol. However, it could mean you’re losing blood somewhere in your gastrointestinal tract, such as in the stomach or small intestine.

4. Oily or Greasy Stools
If you have poop that appears oily, has a greasy consistency and is difficult to flush, it could be a signal that your body is not able to properly digest fat. The consistency changes could be caused by an infection, nutrients not being digested due to celiac disease or a problem with the pancreas, such as pancreatic cancer or pancreatitis.

​5. Pencil-Thin
Stool that is only occasionally very thin is not a cause for concern. It is likely due to muscle contractions in the large intestine as it helps to concentrate waste.

If there is a sudden and consistent change in your stool always being thin, it could mean there is a blockage in your colon, and you should see your doctor.
​Source

The Scoop About Healthy Poop
Your bowel movements can offer important clues about your health; Viruses and bacteria in the intestinal tract can cause stool discoloration, diarrhea or blood in the stool. The color of the blood can help your doctor pinpoint the location of the infection. If an infection is in the lower intestines or colon, then the blood in your stool is going to be red. If you find black blood, then the blood has oxidized and is from higher up in your digestive tract, such as the stomach or upper intestines. People with gallbladder disease sometimes have white stools, so if you ever notice white bowel movements, contact your doctor.
Read the 2016 article, here.

Many medical conditions can affect stool. White or gray stool may indicate liver disease; dark or bloody stool can indicate internal bleeding, including hemorrhoids; tar-like black stool may be the result of gastrointestinal bleeding. Bright red blood may indicate hemorrhoids, but rectal bleeding may also be a symptom of more serious disease. Any unusual, painful or unexplained bowel symptom that persists for a week or more calls for medical evaluation, according to an article published in the February 2016 UC Berkeley Wellness Letter.
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