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Wednesday, September 24, 2008

Diet & Nutrition in Liver Disease :: Nutrition guidelines

Diet & Your Liver


What does nutrition have to do with your liver?
Nutrition and the liver are interrelated in many ways.
Some functions are well understood; others are not.
Since everything we eat, breathe and absorb through
our skin must be refined and detoxified by the liver,
special attention to nutrition and diet can help keep the
liver healthy. In a number of different kinds of liver
disease, nutrition takes on considerably more importance.
Why is the liver so important in nutrition?

85-90% of the blood that leaves the stomach and
intestines carries important nutrients to the liver where
they are converted into substances the body can use.

The liver performs many unique and important metabolic
tasks as it processes carbohydrates, proteins, fats and
minerals to be used in maintaining normal body functions.

Carbohydrates, or sugars, are stored as glycogen in the
liver and are released as energy between meals or when
the body's energy demands are high. In this way, the liver
helps to regulate the blood sugar level, and to prevent a
condition called hypoglycemia, or low blood sugar.
This enables us to keep an even level of energy throughout
the day. Without this balance, we would need to eat

constantly to keep up our energy.

Proteins reach the liver in their simpler form called
amino acids. Once in the liver, they are either released
to the muscles as energy, stored for later use, or converted
to urea for excretion in the urine. Certain proteins are
converted into ammonia, a toxic metabolic product,
by bacteria in the intestine or during the breakdown of
body protein. The ammonia must be broken down by the
liver and made into urea which is then excreted by the
kidneys. The liver also has the unique ability to convert
certain amino acids into sugar for quick energy.

Fats cannot be digested without bile, which is made in the
liver, stored in the gallbladder, and released as needed into
the small intestine. Bile (specific bile "acids"), acts somewhat
like a detergent, breaking apart the fat into tiny droplets so
that it can be acted upon by intestinal enzymes and absorbed.
Bile is also essential for the absorption of vitamins A, D, E, and
K, the fat soluble vitamins. After digestion, bile acids are
reabsorbed by the intestine, returned to the liver, and
recycled as bile once again.

Can poor nutrition cause liver disease?
There are many kinds of liver disease, and the causes of most
of them are not known. Poor nutrition is not generally a cause,
with the exception of alcoholic liver disease and liver disease
found among starving populations. It is much more likely that
nutrition is the result of chronic liver disease, and not the cause.

On the other hand, good nutrition - a balanced diet with
adequate calories, proteins, fats, and carbohydrates - can
actually help the damaged liver to regenerate new liver cells.
In fact, in some liver diseases, nutrition becomes an essential
form of treatment. Patients are strongly advised not to
take megavitamin therapy or to use nutritional products
bought in special stores or by catalogue without
consulting a doctor.
How does liver disease affect nutrition?
Many chronic liver diseases are associated with malnutrition.
One of the most common of these is cirrhosis. Cirrhosis refers
to the replacement of damaged liver cells by fibrous scar tissue
which disrupts the liver's important functions. Cirrhosis occurs
as a result of excessive alcohol intake (most common), common
viral hepatitis, obstruction of the bile ducts, and exposure to
certain drugs or toxic substances.

People with cirrhosis often experience loss of appetite,
nausea, vomiting and weight loss, giving them an emaciated
appearance. Diet alone does not contribute to the development
of this liver disease. People who are well nourished, for example,
but drink large amounts of alcohol, are also susceptible to
alcoholic disease.

Adults with cirrhosis require a balanced diet rich in protein,
providing 2,000 to 3,000 calories a day to allow the liver cells
to regenerate. However, too much protein will result in an
increased amount of ammonia in the blood; too little protein
can reduce healing of the liver. Doctors must carefully prescribe
the correct amount of protein for a person with cirrhosis.
In addition, the physician can use two medications
(lactulose and neomycin) to control blood ammonia levels.
What other nutritional problems are caused
by cirrhosis?
When the scarring of cirrhosis interferes with the flow of blood
from the the stomach and intestines to the liver, a condition
called portal hypertension may develop. This simply means that
there is back pressure in the veins entering the liver. Surgical
"shunting", or rerouting of blood away from the liver and into the
general circulation can relieve this pressure, but it often causes
a new set of problems. Because the shunted blood has bypassed the
liver, it contains high levels of amino acids, ammonia, and possibly
toxins. When these compounds reach the brain, they cause a condition
called hepatic encephalopathy, which means "liver caused mental
impairment." Patients become confused and some temporary loss of
memory occurs.
Can diet help in treating other complications of
cirrhosis?
There are a number of complications of cirrhosis which can
be helped through a modified diet.

Persons with cirrhosis often experience an uncomfortable
buildup of fluid in the abdomen (ascites) or a swelling of the feet,
legs, or back (edema). Both conditions are a result of portal
hypertension (increased pressure in the veins entering the liver).
Since sodium (salt) encourages the body to retain water, patients
with fluid retention can cut their sodium intake by avoiding such
foods as canned soups and vegetables, cold cuts, dairy products,
and condiments like mayonnaise and ketchup. In fact, most
prepared foods contain liberal amounts of sodium, while fresh
foods contain almost no sodium at all. A good-tasting salt substitute
is lemon juice.

Are there other liver diseases where specific changes
in diet can help?
Nutrition and a modified diet have been found to have a significant
effect on a number of other liver diseases. Some types of liver
disease, for example, cause a backup of bile in the liver which is
called cholestasis. This means that bile cannot flow into the small
intestine to aid in the digestion of fats. When this happens, fat is not
absorbed but instead is excreted in large amounts in the feces, which
become noticeably pale-colored and foul-smelling. This condition is
known as steatorrhea. This loss of fat calories may also cause
weight loss.

Special fat substitutes, such as medium chain triglycerides
(MCT oil) and safflower oil can help alleviate this condition
because they are less dependent on bile for intestinal absorption.
They can be used like other oils in cooking, baking and salad dressings.

Patients with steatorrhea may also have difficulty absorbing fat
soluble vitamins A, D, E, K. However, water soluble vitamins are
absorbed normally. Supplementing the diet with fat soluble vitamins
is possible, though it should only be carried out under the guidance
of a physician. Vitamin A in excess over what is needed is very toxic
to the liver.

Diet for liver disease

A healthy liver is like a processing plant. Carbohydrates, proteins,
fats, vitamins, and minerals all go to the liver where they are broken
down and stored. Later, they are remade into whatever the body
needs and carried through the bloodstream to wherever they will
be used.

Even when the liver is damaged, these nutrients still come to the
liver after they have been digested. But, once they arrive, the liver
cannot process them and they build up. This build-up causes more
liver damage.

As a result, what a person with liver disease eats is very important.
This diet needs to provide nutrients without causing further harm to
the liver. This type of diet would include:

  • A limited amount of protein. A damaged liver cannot process
    protein very well. This causes a build-up of ammonia in the
    bloodstream.

  • Sore carbohydrate. Carbohydrate is the body's energy supply.

  • A healthy liver makes glycogen from carbohydrate.

  • The glycogen is then broken down when the body needs energy.

  • A damaged liver can't do this. Without glycogen, more carbohydrate is needed from the diet to make sure the body has enough energy.

  • A moderate amount of fat. Fat provides calories, essential fatty acids, and fat-soluble vitamins.

  • A limited amount of fluids and sodium. Liver damage can cause high blood pressure in the major vein of the liver. This can result in ascites, a fluid build-up in the abdominal cavity. Limiting fluids and sodium can help prevent this.

  • Extra amounts of certain vitamins and minerals. A damaged liver has problems storing many vitamins and minerals.

Liver "sluggishness" is often blamed for poor appetite, listlessness,
poor digestion and bad health. In fact, only in a minority of instances,
is the liver to blame in these situations.
Specifically, only in liver disease which may take the form of hepatitis
or cirrhosis will ill-health be due to the liver.

Diet For A Healthy Liver

A balanced diet with plenty of fruits, vegetables, animal protein with
a fat - carbohydrate - protein ratio of 30% - 50% - 20% unless specific
problems such as diabetes, kidney disease etc dictate otherwise. ·

  • Plenty of fluids
  • Avoidance of excess alcohol
  • Pack your diet with antioxidants

Anti-oxidants protect against free radical (produced in all of us
due to body's metabolic processes) injury. Apart from protecting
the liver and helping in its recovery if damaged, they have been
shown to inhibit cancer cells, fight the ageing process and protect
he sight.

Antioxidants are abundant in fruits and vegetables, as well as
other foods including nuts, grains and some meats, poultry
and fish. Below are some of the anti-oxidants and their best food
sources.

Beta-carotene
Found in many foods that are orange in color, including sweet
potatoes, carrots, apricots, pumpkin, and mangos. Some green
leafy vegetables such as spinach and kale are also rich in
beta-carotene.

Lycopene
A potent antioxidant found in tomatoes, watermelon, guava,
papaya, apricots, oranges

Selenium
Selenium is a mineral, not an antioxidant nutrient. However,
it is a component of antioxidant enzymes. The amount of selenium
in soil, which varies by region, determines the amount of selenium
in the foods grown in that soil. Plant foods like rice and wheat are
the major dietary sources of selenium in most countries

Vitamin A
Foods rich in vitamin A include liver, sweet potatoes, carrots,
milk, egg yolks and mozzarella cheese.

Vitamin C
This can be found in abundance in citrus fruits (lemons, oranges etc.),
cereals, poultry and fish.

Vitamin E
This is found in almonds, in many oils including safflower, corn and
soybean oils, and also found in mangos, nuts, broccoli and other foods.

A host of over-the-counter anti-oxidant preparations such as
Salymarin (milk thistle) can be taken although unnecessary if above
foods are taken in good quantities.

What is a liver disease diet?
The liver is an organ in the body that does several important tasks.
One task of the liver is to help the body use the nutrients in food
for energy. Liver diseases such as hepatitis and cirrhosis may change
the way your body uses nutrients from food. Nutrients include
carbohydrate (kahr-boh-HEYE-drayt), protein, fat, vitamins and
minerals. Some people with liver disease may not get enough nutrients
and lose weight because of these changes.

A liver disease diet provides the right amount of calories, nutrients, and
liquids for you. A liver disease diet may help your liver work better and
prevent other health problems. The dietary changes you will need to make
depend on the type of liver disease and health problems you have. Your
dietitian (di-uh-TISH-in) or nutritionist (noo-TRI-shun-ist) will tell you
about the type of diet that is best for you.

What can I do to make a liver disease diet part of my
lifestyle?
Changing what you eat and drink may be hard at first. You may need
to make these changes part of your daily routine. Following a liver
disease diet may help you feel better.

Choose a variety of items on this diet to avoid getting tired of having
the same items every day. Keep a list of items allowed on this diet in
your kitchen to remind you about the diet.

Carry a list of items allowed on this diet to remind you about the diet
when you are away from home. Tell your family or friends about this
diet so that they can remind you about the diet.

Ask your caregiver, a dietitian, or a nutritionist any questions you
may have about your diet plan. A dietitian or nutritionist works with
you to find the right diet plan for you. These caregivers can also help
to make your new diet a regular part of your life.

What should I avoid eating and drinking while on a liver
disease diet?
The foods that you need to avoid or limit depend on the type of
liver disease and health problems you have. Following are some of
the dietary changes that you may need to make:

Sodium: You may need to decrease the amount of sodium in your
diet. Sodium causes your body to retain (hold on to) fluids. When
your body holds on to fluids, you will have swelling. Your caregiver
may suggest that you limit or avoid high-sodium foods. Your
caregiver will give you more information about a low-sodium diet.
Some foods that contain high amounts of sodium are the following:

  • Bacon, sausage and deli meats.
  • Canned vegetables and vegetable juice.
  • Frozen dinners.
  • Packaged snack foods like potato chips and pretzels.
  • Soy, barbecue, and teriyaki sauces.
  • Soups.
  • Table salt.

Liquids: You may also have to drink fewer liquids if you have
swelling. Liquids include water, milk, juice, soda, and other
beverages. It also includes any food that contains liquid, such
as soup. This also includes food that melts when it is not cold, such
as gelatin. Talk to your caregiver about the amount of liquid you
may drink each day.

Alcohol: Alcohol may make your liver disease worse. Avoid alcoholic
drinks such as beer, wine, hard liquor (whiskey, gin, vodka) or mixed
drinks (drinks made with hard liquor). Talk to your caregiver if you
have questions about alcohol in your diet.

What can I eat while on a liver disease diet?
Eat ____ grams of protein each day.

Eat ____ grams of sodium each day.

Drink ____ ounces of liquid each day.

Calories: Eat a variety of foods each day to help your liver work
as well as possible, and to keep a healthy weight. You may not feel
hungry or you may feel full right away after eating. This may make
it hard for you to eat enough calories. Eat several small meals
throughout the day instead of large meals to make sure you eat
enough calories. Ask your dietitian or nutritionist how many calories
you need each day.

Protein: It is important to eat the right amount of protein when
you have liver disease. Your dietitian or nutritionist will tell you
how much protein you should have each day. The following foods
are good sources of protein. The amount of protein (in grams)
follows each listed food.

  • Three ounces of meat, poultry (chicken), or fish (21 grams).
  • One cup of milk or yogurt (eight grams).
  • One large egg (seven grams).
  • Two tablespoons of peanut butter (seven grams).
  • One-half of a cup of tofu (seven grams).
  • One-fourth of a cup of cottage cheese (seven grams).
  • One ounce of cheese (seven grams).
  • One-half of a cup of cooked, dried, pinto, kidney or navy beans (three grams).

Fat: Your caregiver will tell you how much fat you should have
in your diet each day. Some people with liver disease have problems
with digesting (breaking down) and absorbing (using) fat. The fat that
is not broken down and used by the body is lost in bowel movements.
If you have this health problem, you may need to eat less fat. Your doctor
may also suggest that you eat a special type of fat that is absorbed more
easily by your body.

Carbohydrates: Your caregiver will tell you how much carbohydrate
you should eat each day. Carbohydrates are found in breads, cereals,
grains (rice, oats), starchy vegetables (potatoes, corn, peas), and
crackers. Liver disease may cause blood sugar levels to be too high
or too low in some people. You may need to make changes in your
diet if you have this problem. Eating certain amounts of carbohydrates
at each meal helps to control blood sugar levels.

What other diet guidelines should I follow?
Talk to your caregiver before taking any vitamins or herbal
supplements (pills).

Talk to your dietitian or nutritionist about any other diet changes
you should make. Liver disease may cause several different health
problems. Your caregiver may suggest that you make other diet
changes that can help to improve your health.

Risks:

You may not get enough nutrients and lose weight if you do not
eat a balanced diet. Not following a liver disease diet may cause
certain health problems to become worse.

Liver disease may cause you to lose your appetite and feel full
too quickly after eating. This may make it hard for you to eat
enough calories. Talk to your caregiver if you are having trouble
eating and drinking.

Care Agreement:

You have the right to help plan your care. To help with this plan,
you must learn about your diet. You can then discuss treatment
options with your caregivers. Work with them to decide what care
may be used to treat you. You always have the right to refuse
treatment.

Eat for health

Since everything we eat must pass through the liver, special
attention to nutrition and diet can help keep me healthy.
Here are some tips on eating for health healthy liver, healthy you!

Eat a well balanced, nutritionally adequate diet. if you enjoy foods
from each of the four food groups, you will probably obtain the
nutrients you need.

Cut down on the amount of deep-fried and fatty foods you and your
family consume. Doctors believe that the risk of gallbladder disorders
(including gallstones, a liver-related disease) can be reduced by avoiding
high-fat and cholesterol foods.

Minimize your consumption of smoked, cured and salted foods.
Taste your food before adding salt! Or try alternative seasonings
in your cooking such as lemon juice, onion, vinegar, garlic, pepper,
mustard, cloves, sage or thyme.

MEAT, FISH, POULTRY & ALTERNATIVES PROVIDE:
protein, vitamin A, iron, vitamin B12, niacin, fiber, thiamin

BREADS AND CEREALS PROVIDE:
carbohydrates, niacin, thiamin, iron, riboflavin, fiber

FRUITS AND VEGETABLES PROVIDE:
vitamin A, vitamin C, iron, fiber, folacin

MILK AND MILK PRODUCTS PROVIDE:
calcium, riboflavin, niacin,folacin, vitamin A, vitamin B12, vitamin D

Increase your intake of high-fiber foods such as fresh fruits and
vegetables, whole grain breads, rice and cereals. A high-fiber diet
is especially helpful in keeping me healthy.

Rich desserts, snacks and drinks are high in calories because of the
amount of sweetening (and often fat) they contain. Why not munch
on some fruit instead?

Keep your weight close to ideal. Medical researchers have established
a direct correlation between obesity and the development of gallbladder
disorders.

Vegetarianism and The Liver

The liver has been described as a chemical workshop of the human
body. All the nutrients and other substances absorbed from the
intestines pass through the liver before entering into the systemic
circulation. Thus the liver is vulnerable to the damage caused by a
host of infections and toxic agents. Several types of viruses and alcohol
are by far the commonest of these agents. The impairment of the liver
function usually manifests as jaundice. Persistent infection and continuing
impairment of function may be followed by death unless these changes can
be controlled.
The morphological changes in liver damage can manifest as fatty liver,
hepatitis, cirrhosis of the liver and cancer of the liver.
A well planned dietary regimen is of utmost importance in the prevention
and treatment of most hepatic disorders. It has been proved beyond doubt
that some of the proteins derived from animals are responsible for
producing persistent symptoms related to liver disease. Thus vegetarian
diet, as mentioned below, has gained momentum in the treatment of hepatic
disorders.

Viral Hepatitis
Since there are no antiviral agents against hepatitis,rest, abstinence from
alcohol and dietary modifications form the mainstay of the treatment.
Most patients have nausea and lack of appetite. They should be served wit
attractive and well cooked foods. Small meals served separately will be
better tolerated than three large meals. A diet containing approximately
2000 kcal which can be provided by 20-25 gms fat, 80-90 gms pro teins
and 400 gms carbohydrate is suitable. This requirement can be fulfilled by
glucose, sugar, fruits, fruit juices, bread, cereals, vegetables, salads, jelly, jam
, rice, boiled potatoes and puddings made with cereals and sugar. Though
diets high in their fat content do not ultimately influence the course of the
disease they are poorly tolerated by jaundiced patients. Fried food, milk
and butter cause dyspepsia and should be avoided. Thus a vegetarian diet
is better tolerated by the patients suffering from viral hepatitis.

Cirrhosis of Liver
Most of the patients of cirrhosis of liver are severely malnourished and
require a high calorie and high protein diet. A high protein diet, particularly
if derived from animal proteins, carries a high risk of precipitating hepatic
encephalopathy. The best source of vegetarian proteins is milk, its products
and Casilan. Choline present in foods like wheat germ, soyabean, peanuts and
skimmed milk may prevent the formation of a fatty liver. It is also believed
that cerebral disturbances due to liver damage are caused by the type of
protein in the diet. Cirrhotic diet prescribed in a standard Indian books
on diet and nutrition does not contain proteins derived from animal sources.
A diet high in carbohydrate and proteins low in fat and fortified with vitamins
would be most suitable. Thus a vegetarian diet is more suited to patients
having cirrhosis of liver.

Ascites
In terminal stages of cirrhosis fluid accumulates in the abdominal cavity
due to failure of the liver to synthetize plasma albumin. For such patients,
a high protein diet which is low in sodium would be most suitable. But
since these patients have no appetite, milk is the only practical diet which
can supply the above requirements.
Finally when the liver fails - the condition is known as hepatic encephalopathy.
There is a strong incidence of animal protein intake increasing the incidence
of hepatic encephalopathy. The clinical features of this syndrome are sleep
disturbances, restlessness, drowsiness, impaired intellectual function,
confusion and stupor progressing to coma. Significant number of these
patients develop chronic encephalopathy and can be managed successfully
at home. They should be given 20 gms of protein in the diet. This should
mainly be derived from skimmed milk.

Thus, it is very obvious that a vegetarian diet is more useful in the treatment
of all liver disorders including the last stage of liver failure.

Support Liver Detoxification With Your Diet

Your liver plays a complex role in many critical functions in your body.
A one-word summation of its task could be "detoxification." If there are
nutritional deficiencies in your diet, your liver will have difficultly eliminating
toxins, which will in turn increase the amount of toxins produced by your body.

Toxins and your liver

Toxins come from variety of sources. They come from the environment,
the content of our bowels, the food we eat, the water we drink, and the air
we breathe. If you are exposed to chemicals or cigarette smoke, it is your
liver's job to clean up the toxins before they do damage.

The liver removes toxins in three ways:

  • It filters the blood.
  • It neutralizes toxins by excreting fat-soluble toxins with cholesterol through making bile.
  • It breaks down toxins with enzymes in a two-step process usually referred to as phase I and phase II detoxification.

A good diet helps your liver detoxify

To support proper liver function, it is important to eat a healthy diet
that includes a variety of vegetables, which provide a wide range of
essential nutrients. Your liver needs these nutrients to perform its duties.
Some of the best things you can do for your liver include:

Eat a high-fiber diet. Fiber binds to the bile in the large intestines,
which helps to transport it out of the body. This is one of the ways the
body eliminates fat-soluble toxins from the body.

Include variety in your diet. Eat a wide variety of nutrient-rich foods,
including foods high in antioxidants (vitamin C, beta carotene and vitamin E)
and high in B vitamins, calcium, and trace minerals to protect the liver from
damage and help it do its job.

Watch your B vitamins. Make sure to get enough choline, betaine,
methionine, vitamin B6, folic acid and vitamin B12. These special
nutritional factors are needed to promote liver decongestion,
improve liver function and metabolize fat.

Use a medically supervised fast to aid in detoxification. A fast
can quickly increase elimination of waste and enhance your body's
healing processes. Fasting is not right for everyone, however;
talk to your doctor to learn what fast is appropriate for you.

Important nutrients for your liver

A diet high in fiber includes a wide variety of plant-based foods.
The best way to increase fiber is to eat more vegetables, beans
and fruit. Foods that contain vitamins C and E are important as
antioxidants to protect and treat a damaged liver. B vitamins are
often depleted when the liver is overworked from alcohol consumption
or toxic exposure. Methionine and cysteine are sulfur-containing
proteins that are known to protect the liver and aid in converting
fat-soluble toxins to water-soluble substances that can be eliminated
through the urine. Choline is needed to metabolize fats in the body.
Foods that contain these vitamins include:

Vitamin C. Rose hips, kale, parsley, collard greens, mustard greens,
cauliflower, red cabbage, strawberries, papaya, spinach, kiwi fruit,
citrus fruits, asparagus, mangos, peppers, broccoli, and Brussels sprouts.

Vitamin E. Almonds, filberts, sunflower seeds, avocados, asparagus,
walnuts, tomatoes, whole grains, and green leafy vegetables.

B-complex. Nutritional yeast, sunflower seeds, almonds, peanuts, pine nuts,
sesame seeds, buckwheat, wild rice, and brown rice.

Methionine and cysteine. Egg yolks, red peppers, garlic, onions, broccoli,
Brussels sprouts, sesame seeds, whole grains and beans.

Choline. Soybeans, egg yolks, nutritional yeast, fish, peanuts, cauliflower,
lettuce, cabbage, lentils, chick peas and brown rice.

Making specific dietary changes to aid your liver in detoxification can
be simple. Eating a wide variety of organic vegetables, fruits, seeds,
nuts, beans and whole grains gives your body the fiber and the nutrients
it needs to protect and support healthy liver function.

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