Branched Chain Amino Acids (From Medscape)

[HysteryDiagnosis]

I had done some reading for a friend who had Hepatitis some 10 or 12 years ago... I came across BCAA's.... I didn't understand why someone was pushing BCAA's for liver disorders... it all makes sense to me now. BCAA's have been on the shelves of more than 2 healthfood stores for longer than I can remember.


Big hooha freaking warning, Medscape has an ad on their page.

If the link doesn't work, just Google for BCAA Liver Disease, 5th result is you.

http://www.medscape.com/viewarticle/575158_6

Several studies have investigated the benefits of the addition of BCAA in the recommended oral diets in ESLD. The results are controversial,<34> but the majority of authors tend to recognize that BCAA can improve the clinical outcome if prescribed to patients with established nutritional deficit.<9,27,37>

The first and most well-accepted clinical condition in which BCAA are recommended is in patients with hepatic encephalopathy with intolerance to enteral protein as it is stated in the ESPEN guidelines. The exact role of BCAA in patients with hepatic encephalopathy can be explained by their pathophysiological role in the blood–brain barrier. The brain uptake of tryptophan in patients with hepatic encephalopathy is increased due to the decreased ratio of endogenous BCAA/tryptophan in cirrhosis. The actual cause of this is the effect of hyperinsulinemia and the decreased postabsorptive removal of non-BCAA by the affected liver. As BCAA compete with tryptophan for the same amino acid transporter in the blood–brain barrier, the decreased ratio leads to an easier passage of tryptophan in the brain circulation.<38,39>

A study that was designed to prove the efficacy of BCAA in protein-intolerant patients with hepatic encephalopathy has enrolled patients who could not ingest more than 40g protein without deterioration of hepatic encephalopathy. They were given 70g protein either in the form of casein or BCAA supplement. A deterioration of encephalopathy was observed in almost half of the patients in the casein group and in only one in the BCAA group.<40> This study gives basis to the ESPEN recommendations about the use of BCAA formulae.

BCAA have an additional role in energy metabolism. They are not only used as substrates in protein synthesis but they regulate protein synthesis and consequently keep the skeletal muscles intact. The long-term use of BCAA in liver cirrhosis leads to an increase of serum protein of approximately 10% if given before bedtime.<38>