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Forum Name: Liver Diseases

Question: Alagille syndrome


 ekrumova - Sun Jul 25, 2010 11:08 am

Hello,

I have a 4 years old daughter, diagnosted with Alagille syndrome.
For the moment all results are fine. She takes ADEKs vitanims, Magnesium and Ursodeoxycholic acid.
I wonder can I give her fish oil?
 Dr.M.Aroon kamath - Mon Aug 16, 2010 12:31 pm

User avatar Hi
Alagille syndrome is an autosomal dominant disorder manifesting with a number of abnormalities including those of the heart, eye, liver, kidneys and skeleton, and characteristic facial features.

The cardiac anomalies commonly seen are Fallot's tetralogy, peripheral pulmonic stenosis, atrial and ventricular septal defects, and patent ductus areteriosus.The liver abnormalities consist of a paucity of biliary ducts or cholestatic liver disease.Liver disease is the major cause of morbidity. Because of the paucity of biliary ducts, little bile only is able to enter the duodenum.

I do not understand in which context, you would like to give her fish oil -- is she really deficient in essential fatty acids?, or is it because you feel that absorption of essential fatty acids is impaired due to lack of bile, or is it that you want to give it for its cardiovasular beneficial effects?

Omega-3 fatty acids are said to afford protection from cardiovascular disease (evidence mostly in the context of atherosclerotic heart disease and not congenital heart disease)

Several studies have shown that compared with saturated fatty acids, major dietary essential fatty acid (EFA), linoleic acid (LA)absorption and status remain relatively well-preserved despite quantitative or qualitative changes in intestinal bile salt secretion.

Of late, fish oils have raised some concerns. One major concern is that the fish from which they are manufactured may be poisoned with heavy metals and other marine pollutants.Polychlorinated biphenyls (PCBs) and mercury dioxins have been found in some species of fish.

Stomach upsets are frequent side effects of fish oil supplements. Diarrhea may also occur, large doses capable of causing potentially severe episodes.There are also reports of increased acid reflux, increased belching, indigestion, flatulence and abdominal pain. Fishy aftertaste is quite common.

These gastrointestinal side effects can be reduced by taking fish oils with meals and by starting low doses and gradually increasing the dose.
However, mostly these side effects are associated with eating whole fish(potentially contaminated) rather than as the oil alone.

If the oil is fish ‘liver oil’(ex; cod liver oil), it also contains vitamin A. Large doses can result in vitamin A toxicity.

Although Omega-3 fatty acids are good for health, as far as your child is concerned, you have to critically weigh the risk- to- benefit ratio.There is an alternative source of Omega-3 fatty acids as well - and that, is from vegetarian sources. I will avoid giving a list of nuts, whole grains and green, leafy vegetables here (you can easily access them on the web) which are a rich source of alpha- linolenic acid (ALA), which in the body, gets converted to eicosapantaenoic acid (EPA), which is an omega-3 fatty acid.These do not have the risks associated with fish oils.

Therefore, you must discuss with your child’s pediatrician and a dietitian regarding the need and (if needed), how best to supplement the Omega-3 fatty acids.
Best wishes!

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