Hi @techi,

With regard to high ammonia levels, I couldn't find other members besides @contentandwell, who may be able to give you more information.
Ammonia comes from protein in the diet, and there is some evidence that shows people with high levels of ammonia do better when they get their protein from vegetables (beans, lentils) and from dairy products (eggs, milk, yogurt) instead of from meats.
The Lactulose is prescribed to push food through the bowels more quickly. That way, less food is absorbed, the liver has less work to do, and fewer toxins make their way to the brain.