After being told that there was nothing wrong with me for three years a geneticist discovered that my ammonia levels (reference range is 12-47 umol/L) were double and triple what they should have been after
eating. I should also note that during that time I was having Ensure meal replacements as I thought this was a healthier option. After cutting down on protein, taking lactulose (30ml/3x/day) and starting Rifaximin (600mg/2x/day for the encephalopathy) my symptoms quickly started to improve.