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Nevertheless, a large study (n=646) from Japan in patients with decompensated cirrhosis of mixed etiology has shown reduction in episodes of decompensation or mortality over 2 years using a diet supplemented with 1.01.4 g protein/kg/d, BCAA and 2535 kcal/kg/d

Feeding diabetes-prone BioBreeding (BBdp) rats a hydrolyzed casein-based diet, a diet that binds nutritional copper and lowers tissue copper, promotes islet cell neogenesis and results in 23-fold fewer diabetes cases compared with feeding cereal-based diets [ 43 ]

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Mechanisms underlying Herxheimer reactions Managing Herxheimer reactions often comes down to one of these three reactions: Immune response activation Central nervous system hypersensitivity Release of pro-inflammatory cytokines Toxicity from microbial cell components Clinical manifestations of Herxheimer reactions Flu-like symptoms (e.g., fever, fatigue, muscle aches) Worsening of existing symptoms New or increased neurological symptoms Importantly, new symptoms shouldnt be interpreted as a Herxheimer reaction initially