A healthy and well balanced diet is a pre-requisite for general good health. The food we consume is responsible for providing us with energy and maintaining and repairing our body. It also influences our immune system and our body's response to disease or illness. However, our diet can also hinder good health and immune function. The role diet plays in diseases such as coronary heart disease and stroke is well documented. Less well documented is the role diet plays in liver disease, but as all foods and fluids must pass through the liver to be metabolised, diet must play an important role.
The most appropriate diet is going to depend on a number of factors; age, weight, extent of liver damage, your symptoms, and is well worth discussion with a dietician (you can ask your GP or consultant for a referral to a dietician). However there are some basic changes you can make to your diet that could help protect your liver.
The most important diet modification that can be made at this stage is the exclusion of any substances that may be toxic to the liver, or hard for the liver to break down causing further damage or putting the liver under unnecessary stress, in particular alcohol and foods high in fat content, especially saturated fats. Your doctor will be able to advise you about hepatotoxic drugs.
Food to include in your diet
1. Fresh fruit and vegetables
2. Complex carbohydrates
3. Adequate amounts of protein
4. Foods rich in fibre
5. Foods low in fat
Foods to avoid:
1. Fried foods
2. Fatty foods especially saturated and hydrogenated fats
3. Processed food and junk food
4. Foods containing additives and pesticides.
Diet and liver damage
Over time, and this may be over a very long period of time, your hepatitis C infection will most likely begin to damage your liver and as a result dietary advice may change. There is no single diet for all to follow, as the course of liver disease and the effect on the liver will be different in different people. However, there are some common developments and conditions that are affected by diet:
Iron
The liver plays an important role in the metabolism of iron. Approximately 10% of the iron we consume is naturally excreted from our body. People with chronic hepatitis C sometimes have difficulty in releasing iron; this can result in an overload of iron in the liver, blood, and other organs. Excess iron can be very damaging to the liver and has been cited as a factor that reduces response rates to interferon therapy. Pre-menopausal women are less likely to experience iron overload because of the loss of blood each month.
For this reason, people with chronic hepatitis C should reduce the amounts of iron rich foods in their diet. These include red meats, liver, oysters, tuna, sesame seeds, apricots, prunes and iron-fortified cereals. Interestingly, the tannin in tea is known to block the uptake of iron. It is important to avoid taking iron supplements, unless advised by your doctor. Multivitamin tablets often include iron, so check the label. It is important to also be aware that vitamin C increases the effectiveness of absorption of iron from food.
However, people on interferon combination therapy with ribavirin are likely to experience a loss of haemoglobin, at least at the start of therapy. Anaemia is a known side effect of ribavirin and patients are monitored closely for it. Sometimes a dose reduction of ribavirin is necessary or other drugs are prescribed to combat the depletion of haemoglobin. In some cases it is necessary to discontinue treatment with ribavirin if haemoglobin levels cannot be stabilised, in these instances patients usually continue with interferon alone, known as monotherapy.
Fat
Abnormalities of the liver are more common in those who are overweight. These may include fatty deposits found in the liver and fatty inflammation or fatty cirrhosis, this is more common in diabetics. The presence of fat in the liver can result in the organ becoming enlarged and result in raised liver enzymes.
Overweight patients with a fatty liver who subsequently reduce their weight, are likely to experience an improvement in fat-related liver abnormalities. Consequently people with chronic hepatitis C should try to maintain a normal weight in order to avoid additional stress of their liver.
Protein
The ideal amount and type of protein in the diet of people with liver disease is a much-debated topic and some conflict in opinion is apparent.
Building and maintenance of muscle and repair and healing of the body is highly dependent on protein intake. Adequate protein intake for an adult is approximately 60-120 grams per day. Large amounts of protein in the diet can lead to a build up of protein breakdown products in the blood that are normally eliminated through the liver. If the levels of these products are elevated then a complication known as encephalopathy can occur (see end stage liver disease). This condition affects mental function and is often the cause of brain fog. Several studies have illustrated that a vegetarian diet that restricts or eliminates animal protein improves the symptoms of encephalopathy.
Recent thinking, however, in relation to encephalopathy, is that a very low protein diet is not necessary except for severely ill people and if it is specifically advised by your doctor. Low protein intake can contribute to malnutrition and weakness, therefore the advice is to to continue eating adequate amounts of protein (as opposed to large) but to only eat one type of protein at a time and to avoid eating one large main meal, rather eat 3-4 small ones.
The difficulty still remains of striking a balance between enough protein in the diet to meet the body's needs without a build up of protein breakdown products in the blood.
Most guidelines for daily protein consumption for those with liver disease recommend 1 to 1.5 grams of protein per kilogram of body-weight. However, advice about protein consumption should be gained from your doctor or a dietician after all other medical factors have been taken into consideration.
Salt
Cirrhosis may lead to an abnormal accumulation of fluid in the abdomen referred to as ascites. This is one of the symptoms of end stage liver disease. Those who experience ascites must follow a diet that restricts sodium (salt) to 1000mg per day, although 500mg is better still. This restriction can be very difficult as many foods and food products have a surprisingly high salt content. For example, just one teaspoon of table salt contains 2,325mg of sodium.
Sugar
There appears to be a connection between hepatitis C and problems with the regulation of sugar and subsequent development of diabetes.
The liver is responsible for regulating blood sugar levels. It does this by converting the food we eat into substances that the body can use. Carbohydrates and sugars are stored as glycogen in the liver and are released as energy when the bodys energy demands are high. People with end stage liver disease often have difficulty in regulating blood sugar. One remedy is to consume small, frequent meals that will keep blood sugar levels more constant.
Coffee/Caffeine
Drinks that contain caffeine including coffee, tea and some soft drinks dehydrate the body. Caffeine is processed through the liver and then eliminated from the body via the kidneys. This metabolism process is drastically impaired in the presence of cirrhosis. This can lead to a higher caffeine concentration in the blood. This increased concentration can increase the likelihood of headaches, nervousness, diarrhoea, fatigue, vertigo, insomnia and anxiety. People with hepatitis C should, where possible, avoid drinks that contain caffeine or reduce their intake.
