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General Nutritional Guidelines for individuals
with Liver Disease
About Miss Noreen Aslam
After being diagnosed with liver disease, among the first question that patients
typically ask concerns nutrition. Unfortunately one can't expect to walk into
the doctor's office and request " a diet for liver disease ". Such an
across-the-board diet simply does not exist. Many factors account for the
unfeasibility of a standardized liver diet including variations among the
different stages of liver disease (e.g. stable liver disease without much damage
versus unstable decompensated cirrhosis, complicated by encephalopathy). Other
medical disorders unrelated to liver disease, such as diabetes or heart disease
must also be factored
into any diet. Each person has his or her own individual nutritional
requirements, and these requirements may change over time.
Nutrition and liver disease is a complicated subject. An optimal diet for a
person with stable liver disease (modifications to be made as per individual
needs) might contain all of the factors listed below.
1- 60-70% carbohydrates - Primarily complex carbohydrates, such as whole grain.
2- 20-30% protein - only lean animal protein and/or vegetable protein.
3- 10-20% polyunsaturated fat.
4- 8-12 ounce glasses of water per day.
5- 1,000 to 1,500 milligrams of sodium per day.
6- Avoidance of excessive amounts of vitamins and minerals especially vitamin A,
Vitamin B3 and iron.
7- No alcohol.
8- Avoidance of processed food.
9- Liberal consumption of fresh organic fruits and vegetables.
10- Avoidance of excessive caffeine consumption - no more than 1-3 cups of
caffeine - containing beverages per day.
Protein
Adequate protein intake is important to build and maintain muscle mass and to
assist in healing and repair. Protein intake must be adjusted in accordance with
a person's body weight and the degree of liver damage present. Approximately 0.8
grams of protein per kilogram (2.2 pounds) of body weight is recommended in the
diet each day for someone with stable liver disease.
People with unstable liver disease or decompensated cirrhosis need to lower the
percentage of protein content in their diets so that it falls between
approximately 10-15%. And, they need to eat only vegetable sources of protein. A
diet high in animal protein (which typically contains a lot of ammonia) may
precipitate an episode of encephalopathy among these people.
Vegetarian diets, on the other hand, have a low ammonia content and have been
shown to be much less likely than animal protein diets to induce encephalopathy.
It is important.
Fats
Fats are the body's most efficient means for storing excess energy. Gram for
gram, fats contain more than double the amount of calories of other nutrients.
That is why a diet high in fat is likely to result in more weight gain than a
diet high in calories from protein or carbohydrates. It is important for people
with liver disease to minimize their fat intake by avoiding foods that are high
in fat content. Excess fat can result in a fatty liver or nonalcoholic
steatohepatitis (NASH). Not only can a fatty liver cause liver disease, it may
contribute to the worsening of other liver diseases. e.g. it has been
demonstrated that people with Hepatitis C and a fatty liver are likely to
develop scarring in the liver at an accelerated rate. Furthermore, although
uncommon, it is possible for someone with NASH to develop cirrhosis and liver
failure. In fact, fatty livers are felt to be so unhealthy that they are not
even considered viable for use in transplantation.
People who are overweight should aim for something in the neighborhood of 10%
while it is important to eat as little fat as possible. Eating a small amount of
the more healthy fats does have some benefit. e.g., people need some fat in
order to properly absorb the four fat-soluble vitamins - A, D, E and K. Without
some fat, these vitamins may become deficient in the body, even if they are
taken in supplemental form. This type of vitamin deficiency sometimes occurs in
people with cholestatic diseases such as Primary biliary cirrhosis.
To keep in mind that some popular weight-loss diets involve the consumption of a
very high animal protein content. People with cirrhosis are advised to avoid any
such diets.
Carbohydrate
The major function of carbohydrate is to provide a ready supply of energy to the
body. The liver plays a crucial role in carbohydrate metabolism. Before sugars
are able to supply energy to the body, they are routed to the liver, which is
incharge of deciding their fate. Thus, it may immediately send sugar into the
blood stream to provide an instant energy boost or, the liver may send glucose
to the brain or muscles, depending upon what activities are being performed at
the time, e.g. (taking a test versus exercising) or it may decide to store
glucose (in the form of starch glycogen) for later use. Converting foods other
than carbohydrates into energy is stressful, even to a normal liver. By eating
an unbalanced diet that is low in complex
carbohydrates, a person with liver disease will add to the stress that the
disease has already caused the liver. In fact, this is one reason why so many
people with liver disease feel fatigued. Simply putting, their diets are working
against them.
People with liver disease should strive for a diet consisting of approximately
60-70% carbohydrate, with complex carbohydrates (starches & fibers)
predominating. A well balanced diet will include at least 400 grams of
carbohydrates. If there are too few carbohydrates in a person's diet, this will
likely result in excessive protein & fat intake.
Vitamins and Minerals
The liver is the body's main warehouse for storing nutrients. It absorbs and
stores excess vitamins and minerals from the blood. If a person's diet does not
supply an adequate amount of these nutrients on a given day, the liver releases
just the right amount of them into the bloodstream. However, the liver has only
a limited capacity for processing vitamins and minerals. Any excess amounts that
the liver is unable to process are generally eliminated from the body. Yet, at
same point, the liver can become damaged due to the strain of processing an
overabundance of certain vitamins and minerals (particularly iron, vitamin A and
niacin).
Iron
The liver plays an important role in the metabolism of iron since it is the
primary organ in the body that stores this metal. Patients with chronic
Hepatitis C sometimes have difficulty in excreting iron from the body. This can
result in an overload of iron in the liver, blood and other organs. Excess iron
can be very damaging to the liver. Studies suggest that high iron levels reduce
the response rate of patients with Hepatitis C to Interferon. Thus, patients
with chronic hepatitis C whose serum iron level is elevated, or who have
cirrhosis, should avoid taking iron supplementation. In addition one should
restrict the amounts of iron rich foods in their diet, such as red meats, liver
and cereals fortified with iron, and should avoid cooking in iron coated
utensils.
Sodium
Advanced scarring of the liver (cirrhosis) may lead to an abnormal accumulation
of fluid in the abdomen referred to as ascites. Patients with hepatitis C who
have ascites must be on sodium (salt) restricted diets. Every gram of sodium
consumed results in the accumulation of 200 ml of fluid. The lower the salt
content in the diet, the better this excessive fluid accumulation is controlled.
While often difficult, sodium intake should be restricted to 1000 mg each day,
and preferably to 500 mg perday.
One must become a careful shopper, diligently reading all food labels. It is
often surprising to discover which foods are high in sodium. Meats, especially
red meats, are high in sodium content and adherence to a vegetarian diet may
often become necessary. Patients with chronic hepatitis C without ascites are
advised not to overindulge in salt intake, although their
restrictions need not be as severe.
Alcohol
Alcohol is a potent toxin to the liver. Excessive intake can lead to cirrhosis
and its complications, including liver cancer. Heavy drinkers are not the only
individuals at risk for liver disease as damage can occur in even some moderate
" social drinkers ". The hepatitis C virus has frequently been
isolated from patients with alcoholic liver disease. In fact these patients have
been found to have a higher incidence of severe liver damage, cirrhosis and a
decreased life span, when compared to individuals without the virus. It is
suggested that the combination of alcohol and hepatitis C accelerates the
progression of liver disease. The
consensus statement concerning management of hepatitis C released March 1997
from the National institutes of Health, further warned about the dangers of
excessive alcohol use in patients with hepatitis C. These recommendations
stressed limitations of alcohol use.
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Pakistan Dietetic
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